Research On Pancreatic Duct Stents At Pancreaticoduodenectomy

Objective Postoperative mortality of pancreatoduodenectomy (PD) is with a less than 5% rate in specialized institutions around the world. Nevertheless, the postoperative morbidity still remains high as 30%-40% of the patients with PD. As one of the most common reported complications, postoperative pancreatic fistula (POPF) was reported by various published studies with different conclusions. This study was to aim at providing the evidence of EBM in clinical practice for pncreatic duct sents at PD.Methods The electronic databases were retrieved and Randomised Controlled Trials (RCTs) and Observational studies (OS) of pancreatic duct stents at PD were included. The methodological quality of including studies was_ assessed by the tools provided in Cochrane Handbook. In terms of Trial Sequential Analysis, StatsDirect 3 was used for pooling data, TSA software for required information samples (RIS) of a specific outcome and GRADE pro 3.6 for classification of the evidence. Meanwhile, if there was the lack of adequate participants, the statistical method of Systematic Comparison, including OS with a same issue, was performed to compare with the results of TSA to produce a firm conclusion, as well as Indirect Treatment Comparison. Finally, a retrospective study was conducted to assess these outcomes and SPSS 19.0 for data analyses.Results The results of TSA (eight RCTs), showed that pancreatic duct stents was associated with a significant difference on overall POPF rate, and particularly the external stent. However, the more high-quality data from big sample was needed in future and GRADE illustrated that quality of these postoperative outcomes were low. To confirm an explicit conclusion, Systematic Comparison, pooling 15 OS with the same topics, demonstrated that the results were mostly similar with Trials Sequential Analyses.Moreover, the conclusion of retrospective study indicated that internal stents could not been proven to benefit to PD patients when comparing with non-stents.Conclusions Currently, weak evidence, caused by the lack of number of RCTs and small sample size, demonstrated that there might be potential benefits thanks to the use of pancreatic duct stents, and both external and internal stents are alternative.