title: Current trends in preoperative biliary stenting in patients with pancreatic cancer.
abstract: BACKGROUND
  Sufficient evidence suggests that preoperative biliary stenting is associated with increased complication rates after pancreaticoduodenectomy.
  
  
  METHODS
  Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims data (1992-2007) were used to identify patients with pancreatic cancer who underwent pancreaticoduodenectomy. We evaluated trends in the use of preoperative biliary stenting, timing of physician visits relative to stenting, and time to surgical resection and symptoms in stented and unstented patients.
  
  
  RESULTS
  Pancreaticoduodenectomy was performed in 2,573 patients, and 52.6% of patients underwent preoperative biliary stenting (N = 1,354). Of these, 75.3% underwent endoscopic stenting only, 18.9% received a percutaneous stent, and 5.8% underwent both procedures. The overall stenting rate increased from 29.6% of patients between 1992 and 1995 to 59.1% between 2004 and 2007 (P < .0001). Preoperative stenting was more common in patients with jaundice, cholangitis, pruritus, or coagulopathy (P < .05 for all). Of stented patients, 77.7% had had a stent placed prior to seeing a surgeon. Stenting prior to surgical consultation was associated with longer indwelling stent time compared to stenting after surgical consultation (37.3 vs 27.0 days, P < .0001). In addition, stented patients had longer times from surgeon visit to pancreatectomy than those who had not received stents (24.2 days vs 17.2 days, P < .0001).
  
  
  CONCLUSIONS
  Use of preoperative biliary stenting doubled between 1992 and 2007 despite evidence that stenting is associated with increased perioperative infectious complications. The majority of stenting occurred prior to surgical consultation and is associated with significant delay in time to operation. Surgeons should be involved early in order to prevent unnecessary stenting and improve outcomes.
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX 77555-0541, USA.
authors.forename: Lindsay J
authors.initials: LJ
authors.lastname: Jinkins
authors.forename: Abhishek D
authors.initials: AD
authors.lastname: Parmar
authors.forename: Yimei
authors.initials: Y
authors.lastname: Han
authors.forename: Casey B
authors.initials: CB
authors.lastname: Duncan
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Sheffield
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Brown
authors.forename: Taylor S
authors.initials: TS
authors.lastname: Riall
mesh_terms: D000368:Aged; D004322:Drainage; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D018426:SEER Program; D015607:Stents
references.citation: J Clin Anesth. 1997 Sep;9(6):437-41
references.pmid: 9278827
references.citation: Acta Chir Scand. 1987 Nov-Dec;153(11-12):665-8
references.pmid: 3434110
references.citation: Ann Surg. 1999 Aug;230(2):131-42
references.pmid: 10450725
references.citation: Am J Surg. 2001 Jan;181(1):52-9; discussion 87
references.pmid: 11248177
references.citation: Arch Surg. 1984 Jun;119(6):703-8
references.pmid: 6428380
references.citation: Dig Surg. 2001;18(5):381-7
references.pmid: 11721113
references.citation: Can J Anaesth. 2006 Mar;53(3):236-41
references.pmid: 16527786
references.citation: Am J Surg. 2003 Nov;186(5):420-5
references.pmid: 14599600
references.citation: Ann Surg. 2012 Sep;256(3):518-28
references.pmid: 22868362
references.citation: N Engl J Med. 2010 Jan 14;362(2):129-37
references.pmid: 20071702
references.citation: Arch Surg. 1998 Feb;133(2):149-54
references.pmid: 9484726
references.citation: Br J Surg. 1994 Aug;81(8):1195-8
references.pmid: 7741850
references.citation: J Gastrointest Surg. 1999 Sep-Oct;3(5):496-505
references.pmid: 10482706
references.citation: J Clin Gastroenterol. 2009 May-Jun;43(5):457-62
references.pmid: 19276992
references.citation: Endoscopy. 1987 Mar;19(2):57-9
references.pmid: 3106022
references.citation: Pancreas. 2010 Mar;39(2):119-26
references.pmid: 19940799
references.citation: J Am Coll Surg. 2001 Jun;192(6):726-34
references.pmid: 11400966
references.citation: Gastrointest Endosc. 2002 Oct;56(4):529-34
references.pmid: 12297769
references.citation: Ann Surg. 2002 Jul;236(1):17-27
references.pmid: 12131081
references.citation: J Am Coll Surg. 2006 Jan;202(1):93-9
references.pmid: 16377502
references.citation: Int J Surg. 2011;9(2):145-9
references.pmid: 21029795
references.citation: Surgery. 1985 Jun;97(6):641-8
references.pmid: 3890241
references.citation: J Clin Oncol. 2000 Feb;18(4):860-7
references.pmid: 10673529
references.citation: Ann Surg. 2010 Nov;252(5):840-9
references.pmid: 21037440
references.citation: Br J Surg. 2005 Mar;92(3):356-61
references.pmid: 15672425
references.citation: Scand J Gastroenterol. 2012 Jul;47(7):827-35
references.pmid: 22507076
references.citation: Anesth Analg. 2009 Feb;108(2):467-75
references.pmid: 19151274
references.citation: Ann Surg. 1985 May;201(5):545-53
references.pmid: 2986562
references.citation: Eur J Surg. 1996 Nov;162(11):881-8
references.pmid: 8956957
references.citation: Ann Surg. 1988 Jan;207(1):39-47
references.pmid: 3276272
references.citation: N Engl J Med. 2000 Jan 20;342(3):168-75
references.pmid: 10639542
references.citation: Am J Surg. 1981 Jan;141(1):61-5
references.pmid: 6779653
references.citation: Br J Surg. 1984 May;71(5):371-5
references.pmid: 6372935
references.citation: J Gastrointest Surg. 2000 May-Jun;4(3):258-67; discussion 267-8
references.pmid: 10769088
references.citation: Arch Surg. 2009 Sep;144(9):841-7
references.pmid: 19797109
references.citation: Langenbecks Arch Surg. 2007 Jan;392(1):67-73
references.pmid: 17089176
references.citation: World J Gastroenterol. 2011 Jan 21;17(3):391-6
references.pmid: 21253401
references.citation: Dig Liver Dis. 2004 Jun;36(6):412-8
references.pmid: 15248382
references.citation: Ann Surg. 2001 Jul;234(1):47-55
references.pmid: 11420482
references.citation: Lancet. 1982 Oct 23;2(8304):896-9
references.pmid: 6126752