A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy Journal Article
| Authors: | Heslin, M. J.; Brooks, A. D.; Hochwald, S. N.; Harrison, L. E.; Blumgart, L. H.; Brennan, M. F. |
| Article 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. Design: A retrospective review of a prospectively collected consecutive series. Setting: The Memorial Sloan-Kettering Cancer Center's Surgical Service, New York, NY. Patients and 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, χ2 test, and Fisher exact test; multivariate analysis was by logistic regression. Significance was defined at P<.05. Main Outcome Measures: 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 intraabdominal 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. |
| Keywords: | controlled study; treatment outcome; aged; middle aged; retrospective studies; major clinical study; liver function; risk benefit analysis; lymph node metastasis; prospective studies; nutritional status; pancreaticoduodenectomy; morbidity; surgical approach; time factors; risk assessment; postoperative complication; postoperative complications; bilirubin; length of stay; hospitalization; jaundice; stent; surgical mortality; preoperative treatment; biliary tract drainage; bilirubin blood level; blood loss, surgical; stents; vater papilla carcinoma; humans; human; male; female; priority journal; article |
| Journal Title: | Archives of Surgery |
| Volume: | 133 |
| Issue: | 2 |
| ISSN: | 0004-0010 |
| Publisher: | American Medical Association |
| Date Published: | 1998-02-01 |
| Start Page: | 149 |
| End Page: | 154 |
| Language: | English |
| DOI: | 10.1001/archsurg.133.2.149 |
| PUBMED: | 9484726 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 12 December 2016 -- Source: Scopus |
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