Application value of preoperative pancreatic duct stenting in function‑preserving pancreatic surgery

Objective To investigate the application value of preoperative pancreatic duct stenting in function‑preserving pancreatic surgery.

Methods The retrospective and descriptive study was conducted. The clinical data of 42 patients who underwent function‑preserving pancreatic surgery at The First Affiliated Hospital of Xi′an Jiaotong University from January 2018 to December 2025 were collected. There were 18 males and 24 females, 35 cases aged <65 years and 7 cases aged ≥65 years. All 42 patients underwent endoscopic retrograde cholangiopancreatography (ERCP)‑guided pancreatic duct stenting before surgery. Observation indicators: (1) surgical conditions; (2) complications; (3) postoperative pathological examination and follow‑up. Measurement data with skewed distribution were expressed as M(range) or M(Q₁,Q₃). Count data were expressed as absolute numbers.

Results (1) Surgical conditions: of the 42 patients, 33 cases had an interval time ≤24 hours between pre-operative ERCP‑guided pancreatic duct stenting and surgery, 9 cases had an interval time >24 hours. There were 24 cases undergoing robotic‑assisted surgery, 13 cases undergoing laparoscopic surgery, and 5 cases undergoing open surgery. For surgical methods, 35 cases underwent tumor enucleation and 7 cases underwent duodenum-preserving pancreatic head resection. The operation time was 200(range, 180-240) minutes for the tumor enucleation and 270(range, 263-365) minutes for the duodenum‑preserving pancreatic head resection, respectively. (2) Complications: for ERCP‑related complications in the 42 patients, there were 3 cases with mild pancreatitis, 7 cases with mild intestinal distension, and no ERCP‑related bleeding or perforation. During the tumor enucleation, there were 3 cases with main pancreatic duct exposure or suspected injury to the wall of the main pancreatic duct, and repairing of the main pancreatic duct was completed with the pre‑placed pancreatic duct stents for assistant localization. Of the 42 patients undergoing pancreatic surgery, 3 cases had postoperative grade B pancreatic fistula, and 2 cases had postoperative grade C pancreatic fistula all complicated by delayed postoperative bleeding and abdominal infection. Postoperative bleeding was controlled through reoperation and postoperative abdominal infection was improved after antimicrobial treatment and unobstructed drainage. No patient experienced delayed gastric emptying after surgery. (3) Postoperative pathological examination and follow‑up: results of post-operative pathological diagnosis showed 16 cases with insulinoma, 14 cases with solid pseudopa-pillary tumor, 5 cases with branch duct intraductal papillary mucinous neoplasm, 4 cases with serous cystadenoma, 2 cases with non‑functional pancreatic neuro-endocrine neoplasm, and 1 case with pancreas divisium combined with pancreaticobiliary maljunction. All 42 patients were followed up for 368(210,469) days after surgery, without surgery related mortality. No new‑onset diabetes mellitus, long‑term pancreatic enzyme replacement therapy for digestive support, or significant diarrhea was observed.

Conclusion Preoperative pancreatic duct stenting for function-preser-ving pancreatic surgery can provide intraoperative identification and protection of pancreatic duct, which can help postoperative recovery and function preservation of the pancreas.