A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy

Martin J. Heslin, Ari D. Brooks, Steven N. Hochwald, Lawrence E. Harrison, Leslie H. Blumgart, Murray F. Brennan

Research output: Contribution to journalArticle

133 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)149-154
Number of pages6
JournalArchives of Surgery
Volume133
Issue number2
DOIs
StatePublished - Feb 1 1998
Externally publishedYes

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Pancreaticoduodenectomy
Stents
Length of Stay
Operating Rooms
Wounds and Injuries
Biliary Fistula
Abdominal Abscess
Pancreatic Fistula
Cellulitis
Operative Time
Nonparametric Statistics
Aspartate Aminotransferases
Infection
Bilirubin
Blood Transfusion
Comorbidity
Neoplasms
Multivariate Analysis
Anesthesia
Logistic Models

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Heslin, Martin J. ; Brooks, Ari D. ; Hochwald, Steven N. ; Harrison, Lawrence E. ; Blumgart, Leslie H. ; Brennan, Murray F. / A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy. In: Archives of Surgery. 1998 ; Vol. 133, No. 2. pp. 149-154.
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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.",
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A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy. / Heslin, Martin J.; Brooks, Ari D.; Hochwald, Steven N.; Harrison, Lawrence E.; Blumgart, Leslie H.; Brennan, Murray F.

In: Archives of Surgery, Vol. 133, No. 2, 01.02.1998, p. 149-154.

Research output: Contribution to journalArticle

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T1 - A preoperative biliary stent is associated with increased complications after pancreatoduodenectomy

AU - Heslin, Martin J.

AU - Brooks, Ari D.

AU - Hochwald, Steven N.

AU - Harrison, Lawrence E.

AU - Blumgart, Leslie H.

AU - Brennan, Murray F.

PY - 1998/2/1

Y1 - 1998/2/1

N2 - 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.

AB - 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.

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