Skip to main content
SpringerLink
Log in

The role of main pancreatic duct stent in the enucleation of benign/borderline pancreatic head tumors: a cohort study

  • Research
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to reveal the role of preoperative main pancreatic duct (MPD) stent placement in reducing the intraoperative main pancreatic duct injury rate and the incidence of postoperative pancreatic leakage following pancreatic tumor enucleation.

Methods

A retrospective cohort analysis was performed for all patients with benign/borderline pancreatic head tumors who were treated with enucleation. The patients were divided into two groups (standard vs. stent) depending on whether they underwent main pancreatic duct stent placement prior to surgery.

Results

Thirty-three patients were finally included in the analytical cohort. Compared with the standard group, patients in the stent group had a shorter distance between tumors and main pancreatic duct (p=0.01) and presented with larger tumors (p<0.01). The rates of POPF (grade B&C) were 39.1% (9/23) and 20% (2/10) in the standard and stent groups, respectively (p<0.01). Major postoperative complications occurred more frequently in the standard group than in the stent group (14 versus 2; p<0.01). No significant differences in mortality, in-hospital stay or medical cost were observed between the two groups (p>0.05).

Conclusions

MPD stent placement prior to surgery may facilitate pancreatic tumor enucleation, minimize MPD injury and decrease the occurrence of postoperative fistula.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Tanaka K, Misawa T, Haruki K, Saito R, Gocho T, Akiba T (2017) Enucleation of solid pseudopapillary tumor with a preoperative nasopancreatic drainage stent in a child. Asian J Endosc Surg 10:438–441

    Article  PubMed  Google Scholar 

  2. Jilesen AP, van Eijck CH, Busch OR, van Gulik TM, Gouma DJ, van Dijkum EJ (2016) Postoperative Outcomes of enucleation and standard resections in patients with a pancreatic neuroendocrine tumor. World J Surg 40:715–728

    Article  PubMed  Google Scholar 

  3. Yu XZ, Li J, Fu DL et al (2014) Benefit from synchronous portal-superior mesenteric vein resection during pancreaticoduodenectomy for cancer: a meta-analysis. Eur J Surg Oncol 40:371–378

    Article  CAS  PubMed  Google Scholar 

  4. Yu X, Li H, Jin C et al (2015) Splenic vessel preservation versus Warshaw's technique during spleen-preserving distal pancreatectomy: a meta-analysis and systematic review. Langenbecks Arch Surg 400:183–191

    Article  PubMed  Google Scholar 

  5. Ohigashi S, Shimada G, Suzuki A, Onodera H (2007) Pancreas-sparing tumor enucleation for pancreatic mucinous cystic neoplasms: experience with two patients. J Hepatobiliary Pancreat Surg 14:167–170

    Article  PubMed  Google Scholar 

  6. Crippa S, Bassi C, Salvia R, Falconi M, Butturini G, Pederzoli P (2007) Enucleation of pancreatic neoplasms. Br J Surg 94:1254–1259

    Article  CAS  PubMed  Google Scholar 

  7. Okamoto T, Gocho T, Futagawa Y et al (2008) Usefulness of pancreatic duct stenting prior to surgery as a guide to decide the feasibility of limited pancreatic resection. Dig Surg 25:175–178

    Article  PubMed  Google Scholar 

  8. Shimura T, Suehiro T, Suzuki H et al (2007) Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic duct disruption during extirpation of a pancreatic head tumor. Am J Surg 194:553–555

    Article  PubMed  Google Scholar 

  9. Maire F, Ponsot P, Debove C, Dokmak S, Ruszniewski P, Sauvanet A (2015) Endoscopic management of pancreatic fistula after enucleation of pancreatic tumors. Surg Endosc 29:3112–3116

    Article  PubMed  Google Scholar 

  10. Misawa T, Imazu H, Fujiwara Y et al (2013) Efficacy of nasopancreatic stenting prior to laparoscopic enucleation of pancreatic neuroendocrine tumor. Asian J Endosc Surg 6:140–142

    Article  PubMed  Google Scholar 

  11. Giuliani T, Marchegiani G, Girgis MD et al (2020) Endoscopic placement of pancreatic stent for "deep" pancreatic enucleations operative technique and preliminary experience at two high-volume centers. Surg Endosc 34:2796–2802

    Article  PubMed  Google Scholar 

  12. Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13

    Article  PubMed  Google Scholar 

  13. Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  14. Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142:761–768

    Article  PubMed  Google Scholar 

  15. Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH) - An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142:20–25

    Article  PubMed  Google Scholar 

  16. Bassi C, Marchegiani G, Dervenis C et al (2017) The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 161:584–591

    Article  PubMed  Google Scholar 

  17. O'Hara LM, Thom KA, Preas MA (2018) Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017): A summary, review, and strategies for implementation. Am J Infect Control 46:602–609

    Article  PubMed  Google Scholar 

  18. Heeger K, Falconi M, Partelli S et al (2014) Increased rate of clinically relevant pancreatic fistula after deep enucleation of small pancreatic tumors. Langenbeck's Arch Surg 399:315–321

    Article  Google Scholar 

  19. Ekinci O (2018) Evaluation of all surgical margins in pancreatic resection specimens by proper grossing techniques: surgical pathology experience of 285 cases. Turk Patoloji Derg 34:242–246

    PubMed  Google Scholar 

  20. Agha R, Abdall-Razak A, Crossley E et al (2019) STROCSS 2019 Guideline: strengthening the reporting of cohort studies in surgery. Int J Surg 72:156–165

    Article  PubMed  Google Scholar 

  21. Jiang L, Ning D, Chen X (2020) Prevention and treatment of pancreatic fistula after pancreatic body and tail resection: current status and future directions. Front Med 14:251–261

    Article  PubMed  Google Scholar 

  22. Hackert T, Hinz U, Fritz S et al (2011) Enucleation in pancreatic surgery: indications, technique, and outcome compared to standard pancreatic resections. Langenbeck's Arch Surg 396:1197–1203

    Article  Google Scholar 

  23. Abe N, Sugiyama M, Suzuki Y et al (2006) Preoperative endoscopic pancreatic stenting for prophylaxis of pancreatic fistula development after distal pancreatectomy. Am J Surg 191:198–200

    Article  PubMed  Google Scholar 

  24. Hirota M, Kanemitsu K, Takamori H et al (2007) Local pancreatic resection with preoperative endoscopic transpapillary stenting. Am J Surg 194:308–310 discussion 11-2

    Article  PubMed  Google Scholar 

  25. Rieder B, Krampulz D, Adolf J, Pfeiffer A (2010) Endoscopic pancreatic sphincterotomy and stenting for preoperative prophylaxis of pancreatic fistula after distal pancreatectomy. Gastrointest Endosc 72:536–542

    Article  PubMed  Google Scholar 

  26. Hashimoto Y, Traverso LW (2012) After distal pancreatectomy pancreatic leakage from the stump of the pancreas may be due to drain failure or pancreatic ductal back pressure. J Gastrointest Surg 16:993–1003

    Article  PubMed  Google Scholar 

  27. Okamoto T, Gocho T, Futagawa Y et al (2008) Does preoperative pancreatic duct stenting prevent pancreatic fistula after surgery? A cohort study. Int J Surg 6:210–213

    Article  PubMed  Google Scholar 

  28. Frozanpor F, Lundell L, Segersvard R, Arnelo U (2012) The effect of prophylactic transpapillary pancreatic stent insertion on clinically significant leak rate following distal pancreatectomy: results of a prospective controlled clinical trial. Ann Surg 255:1032–1036

    Article  PubMed  Google Scholar 

  29. Tian F, Hong XF, Wu WM et al (2016) Propensity score-matched analysis of robotic versus open surgical enucleation for small pancreatic neuroendocrine tumours. Br J Surg 103:1358–1364

    Article  CAS  PubMed  Google Scholar 

  30. Hirashita T, Ohta M, Yada K et al (2018) Effect of pre-firing compression on the prevention of pancreatic fistula in distal pancreatectomy. Am J Surg 216:506–510

    Article  PubMed  Google Scholar 

  31. Idrees K, Edler JR, Linehan DC et al (2013) Cost benefit analysis of mesh reinforcement of stapled left pancreatectomy. HPB (Oxford) 15:893–898

    Article  PubMed  Google Scholar 

Download references

Funding

This work was funded by Shanghai Jiao Tong University Affiliated Sixth People’s Hospital Fund (ynhg202113) and “Shanghai Jiao Tong University Star Program,” Medical-Engineering Interdisciplinary Research Fund (YG2022QN091).

Author information

Author notes

  1. Xinzhe Yu and Wei Wang contributed equally to this work.

Authors and Affiliations

  1. Department of General Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yi-Shan Road 600, Shanghai, 200233, China

    Xinzhe Yu, Chuanxin Yang, Xinyu Huang & Zhou Yuan

  2. Department of Hepato-Pancreato-Biliary Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Xinzhe Yu, Wei Wang, Song Yu, Xinyu Huang & Zhou Yuan

Authors
  1. Xinzhe Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Song Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chuanxin Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xinyu Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zhou Yuan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Xinzhe Yu and Zhou Yuan proposed the study. Xinzhe Yu, Wei Wang, and Zhou Yuan carried out the research. Xinzhe Yu drafted the manuscript. Wei Wang, Song Yu, and Chuanxin Yang collected and analyzed the data. Zhou Yuan and Xinyu Huang kindly offered valuable suggestions about the experiment design. Xinzhe Yu and Wei Wang contributed equally to this article.

Corresponding authors

Correspondence to Xinyu Huang or Zhou Yuan.

Ethics declarations

Ethical approval and consent to participate

The study was approved by the Ethics Committee and Institutional Review Boards of the Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The reference number is 2021-KY-049(K). All patients were exempt from informed consent because of retrospective research type and minimal risks of the study. A verbal form of consent to participate in this study by each patient was obtained during the follow-up process, such as outpatient and telephone.

Consent for publication

In regards to the tables and figures that we submitted, we want to make a formal declaration that we confirm that all the figures and tables are original. We confirmed that all methods were performed in accordance with the relevant guidelines and declaration of Helsinki. All authors were consent for publication.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yu, X., Wang, W., Yu, S. et al. The role of main pancreatic duct stent in the enucleation of benign/borderline pancreatic head tumors: a cohort study. Langenbecks Arch Surg 408, 198 (2023). https://doi.org/10.1007/s00423-023-02921-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00423-023-02921-5

Keywords

Search

Navigation