title: A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy.
abstract: BACKGROUND
  A preoperative biliary stent is commonly used after the initial evaluation of the patient with a periampullary mass.
  
  
  OBJECTIVE
  To evaluate the effect of a preoperative biliary stent on operative difficulty, postoperative complications, and length of hospital stay after a pancreatoduodenectomy.
  
  
  METHODS
  A retrospective review of a prospectively collected consecutive series.
  
  
  METHODS
  The Memorial Sloan-Kettering Cancer Center's Surgical Service, New York, NY.
  
  
  METHODS
  Seventy-four patients underwent pancreatoduodenectomy between March 1, 1994, and February 15, 1996. Thirty-five did not receive a biliary stent, and 39 received a biliary stent prior to medical evaluation. We analyzed patient, nutritional, laboratory, and operating room factors. Univariate analysis was by Student t test, chi2 test, and Fisher exact test; multivariate analysis was by logistic regression. Significance was defined at P<.05.
  
  
  METHODS
  Operative time, amount of blood loss, complications, and length of hospital stay. Wound complications were defined as cellulitis, superficial infections, and deep infections. Intra-abdominal complications were defined as intra-abdominal abscesses and pancreatic or biliary fistula.
  
  
  RESULTS
  Groups were equivalent for tumor size, risk of comorbidity, time spent in the operating room, and amount of blood loss. There was 1 perioperative death. Patients with a stent had significantly lower bilirubin (P<.03) and aspartate aminotransferase (P<.04) levels and a significantly increased risk of nodal positivity (P<.05). The patients with a biliary stent had an increased risk of wound or abdominal complications on univariate (P<.003) and multivariate (P<.02) analysis and tended toward a prolonged hospital stay (P<.04, Wilcoxon signed rank test).
  
  
  CONCLUSIONS
  A preoperative biliary stent was associated with an increased risk of wound or intra-abdominal complications; a stent may prolong the length of hospital stay. However, length of time under anesthesia, amount of blood loss, and transfusion requirements were not altered. A biliary stent should be used with a high degree of selectivity in the management of patients with resectable periampullary masses.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Heslin
authors.forename: A D
authors.initials: AD
authors.lastname: Brooks
authors.forename: S N
authors.initials: SN
authors.lastname: Hochwald
authors.forename: L E
authors.initials: LE
authors.lastname: Harrison
authors.forename: L H
authors.initials: LH
authors.lastname: Blumgart
authors.forename: M F
authors.initials: MF
authors.lastname: Brennan
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D013997:Time Factors