Pancreatic duct stenting during pancreaticoduodenectomy: outcomes from a standardized duct-to-mucosa cohort with propensity score weighting
Irish Journal of Medical Science, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s11845-026-04542-5
- Dergi Adı: Irish Journal of Medical Science
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Anahtar Kelimeler: Biliary leakage, Pancreatic duct stenting, Pancreatic surgery, Pancreaticoduodenectomy, Postoperative pancreatic fistula
- Ankara Üniversitesi Adresli: Evet
Özet
Background: Postoperative pancreatic fistula (POPF) remains one of the most important complications after pancreaticoduodenectomy (PD), and the optimal transanastomotic pancreatic duct drainage strategy remains debated. Aims: To evaluate the association between pancreatic duct stenting strategy and clinically relevant POPF (CR-POPF) after PD. Methods: We retrospectively analyzed consecutive open PDs (2010–2020). Only patients undergoing standardized duct-to-mucosa pancreaticojejunostomy with a transanastomotic stent (external or internal) were included. The cohort comprised 302 patients (external n = 238; internal n = 64). The primary outcome was CR-POPF (ISGPS grade B–C). Propensity score–based inverse probability of treatment weighting (IPTW) was applied. Results: CR-POPF occurred in 9.9% of patients and was lower with external versus internal stenting (8.0% vs. 17.2%, p = 0.029). Biliary leak was also less frequent with external stenting (4.6% vs. 14.1%, p = 0.019). In IPTW-weighted analysis, external stenting was independently associated with lower odds of CR-POPF (OR 0.31, 95% CI 0.14–0.70; p = 0.005). E-value analysis suggested moderate robustness to unmeasured confounding (E-value 5.9). Thirty-day mortality was numerically lower with external stenting (2.5% vs. 7.8%, p = 0.059). Conclusions: External pancreatic duct stenting was associated with lower CR-POPF rates after standardized PD. Prospective randomized studies are needed to confirm these findings and guide stenting strategy selection.