Clinical effects of early removal of an external stent from the viewpoint of postoperative pancreatitis following pancreaticoduodenectomy

Abstract Background: An external stent (ES) prevents clinically relevant postoperative pancreatic fistula (CR-POPF) after pancreaticoduodenectomy (PD), although it requires a longer postoperative hospital stay. Early ES removal has been suggested to overcome this issue. This study aimed to examine the effect of early ES removal on the pathophysiology of postoperative acute pancreatitis (POAP).Methods: This retrospective cohort study was conducted between May 2018 and December 2020 at Amagasaki General Medical Center. The ES was removed on postoperative day 10 if the patient showed no clinical signs of postoperative pancreatic fistula (POPF). The early removal group included patients whose ES was removed within 10 days.Results: Fifty consecutive patients underwent PD with an ES. The median length of postoperative hospital stay was 14.5 days in the early removal group and 19.5 days in the late removal group (P=0.0055). In the multivariate analysis, to eliminate the effects of postoperative complications, late ES removal was associated with a longer postoperative hospital stay (hazard ratio: 2.0, P=0.037). In the multivariate analysis of factors for early ES removal, early removal of the intra-abdominal tubes was statistically significantly associated with early ES removal (odds ratio: 8.4, P=0.03). Although patients with POAP showed a statistically significant delay in the removal of both ES and intra-abdominal drainage tubes, no statistically significant association was observed between CR-POPF and postoperative hospital stay.Conclusions: An ES may manage POAP to reduce the risk of subsequent CR-POPF. Early removal of ES can be a method to shorten hospital stay.