54 Does Preoperative Prophylactic Pancreatic Duct Stenting Prior to Enucleation Mitigate the Risk of Postoperative Fistula: A Meta-Analysis

Abstract Aim Pancreatic enucleation is a surgical technique selectively used for its preservation of pancreatic parenchyma. Despite this, evidence supports enucleation being associated with high rates of postoperative pancreatic fistula (POPF). This meta-analysis aims to evaluate the role of prophylactic preoperative main pancreatic duct (MPD) stenting and its role in reducing the rate of POPF. Method A systematic review and meta-analysis were performed of the pre-existing literature regarding prophylactic pre-enucleation MPD stenting. The primary outcome measure was the rate of clinically relevant POPF (CR-POPF). Data was pooled for analysis using an odds ratio (OR) with a random effects model. Risk of bias was determined as per the MINORS criteria. Results Four cohort studies comprising 197 patients were included, with 78 (39.6%) undergoing prophylactic MPD stenting. All studies used either 5F or 7F stents of varying lengths (4cm to 12cm), inserted either on the operative day or the day prior. Timing of stent removal displayed more heterogeneity (4 weeks to 16 weeks). Stenting was well-tolerated with no reported increased rate of acute pancreatitis, and no reported severe postoperative complications directly attributable to stenting. Crucially, preoperative MPD stenting was associated with a significantly lower rate of CR-POPF (21.8% vs. 45.4%) [OR (95% CI) 0.36 (0.18–0.71), p = 0.0033]. Conclusion Preoperative MPD stenting is associated with a reduced rate of CR-POPF following pancreatic enucleation. Furthermore, preoperative stenting is a well-tolerated intervention with no increased complication burden. These findings merit further prospective randomised investigation into routine stent use in patients undergoing pancreatic enucleation.