Surgery in Practice and Science (Jun 2020)
A retrospective study comparing external and internal without stent pancreatic drainage after pancreatic operation
Abstract
Background: : Postoperative pancreatic fistula (POPF) is one of the most common complications and the leading cause of morbidity and mortality after pancreatic operation with pancreatojejunostomy (PJ). Many strategies have been used to prevent the incidence of POPF, among which drainage of pancreatic juice is effective. There are two types of drainage methods used in clinical practice; however, the method with a superior effect remains unknown. This study compared the effect of external and internal drainage without stent (in other words, no drainage, only PJ by duct-to-mucosa) on the incidence of clinically relevant POPF (CR-POPF) to provide evidence to select a better drainage scheme in clinical practice. Methods: Overall, 520 patients undergoing pancreatic operation, including PJ were included in this single-centre study and were divided into two groups according to drainage methods. We compared the incidence of CR-POPF between the two groups and performed stratified analysis according to the Fistula Risk Score (FRS) and pancreatic gland texture. Factors such as gender, age, Body Mass Index (BMI), operative procedure, and drainage methods were included in univariable and multivariable analyses. Results: The incidence rate of CR-POPF between two groups was significantly different (23.3% vs 13.6%, P < 0.05). In stratified analysis according to gland texture, a significant difference between the incidence rate of CR-POPF of the two groups was observed in class of ‘hard’ (5.7% vs 0%, P < 0.05), but in stratified analysis according to FRS, a difference was not observed. There was a statistically significant difference in postoperative hospitalisation (11.00 vs 10.00, P < 0.001) and hospitalisation expense (RMB 86733.28 vs 84085.89 P < 0.05) between the two groups. In multivariable analysis, pancreatoduodenectomy (PD) (odds ratio [OR]=0.108, 95% confidence interval [CI] 0.038–0.303), pylorus-preserving pancreaticoduodenectomy (OR = 0.070, 95% CI 0.022–0.218), and PD with portal vein/superior mesenteric vein reconstruction (OR = 0.137, 95% CI 0.038–0.498) were associated with a decreased incidence of CR-POPF, whereas external drainage (OR = 1.944, 95% CI 1.144–3.305) was associated with an increased incidence of CR-POPF. Conclusions: Compared with internal drainage without stent or only simple PJ by duct-to-mucosa, the external drainage method was associated with a higher incidence of CR-POPF. However, this conclusion needs to be further confirmed in large samples.
