A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy.
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.
Heslin
M J
MJ
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Brooks
A D
AD
Hochwald
S N
SN
Harrison
L E
LE
Blumgart
L H
LH
Brennan
M F
MF
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