PRE-OPERATIVE ENDOSCOPIC PANCREATIC STENT INSERTION CANNOT REDUCE POST-OPERATIVE PANCREATIC LEAK AFTER DISTAL PANCREATECTOMY: RESULT OF A RANDOMISED CONTROLLED TRIAL leekf@surgery.cuhk.edu.hk

351-02

PRE-OPERATIVE ENDOSCOPIC PANCREATIC STENT INSERTION CANNOT REDUCE POST-OPERATIVE PANCREATIC LEAK AFTER DISTAL PANCREATECTOMY: RESULT OF A RANDOMISED CONTROLLED TRIAL

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Hong Kong, China

Oral or Poster

Post-operative pancreatic fistula (POPF) remains a major problem after distal pancreatectomy (DP). This study evaluates whether pre-operative pancreatic stent placement can lower POPF rate by directing pancreatic juice away from pancreatic stump.

Patients scheduled for DP+/-splenectomy were randomised for pre-operative pancreatic stent (PS) insertion by retrograde cholangiopancreatography (ERCP) or no pancreatic stent (NPS). Primary outcomes measured were incidence and grades of POPF. Secondary outcomes were mortality, morbidity, total length of hospital stay for operation and ERCP.

Between March 2022 and April 2025, 22 PS and 26 NPS were recruited. The patients were comparable on patient demographics, pre-operative blood tests, pathological diagnosis, operative approach and splenectomy rate. Within the PS group, one patient (4.5%) failed to have pancreatic stent insertion, while another patient developed mild acute pancreatitis after ERCP. The two groups were comparable in operative time, operative blood loss and total length of hospital stay. There was one 90-day mortality in the PS group. That patient developed massive intra-abdominal bleeding from splenic artery branch due to slipped metal clip on postoperative day 2 necessitating reoperations. Patient eventually died of liver failure on postoperative day 34. There was no difference in POPF rate: biochemical leak (PS 86.4% vs NPS 92.3%, p=0.649), grade B POPF (PS 13.6% vs NPS 0%, p=0.089), but PS had significantly more post-operative complications (50% vs 15.4%, p=0.010) (Table 1).

Pre-operative pancreatic stent insertion cannot reduce pancreatic leak after distal pancreatectomy, but at the same time it is also associated with more post-operative complications.