This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (69)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Surgery  • Surgical Interventions  • Endocrine Surgery  • Alert me on articles by topic  Social Bookmarking   What's this?

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

Arch Surg. 1998;133:149-154.

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, ² 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 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.

From the Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY. Dr Heslin is now with the Section of Surgical Oncology, University of Alabama at Birmingham.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Pancreaticogastrostomy Decreased Relaparotomy Caused by Pancreatic Fistula After Pancreaticoduodenectomy Compared With Pancreaticojejunostomy
Oussoultzoglou et al.
Arch Surg 2004;139:327-335.
ABSTRACT | FULL TEXT  

Past, Present, and Future of Endoscopic Retrograde Cholangiopancreatography: Perspectives on the National Institutes of Health Consensus Conference
Baron and Fleischer
Mayo Clin Proc. 2002;77:407-412.
 

Localized Adenocarcinoma of the Pancreas: The Rationale for Preoperative Chemoradiation
Wayne et al.
The Oncologist 2002;7:34-45.
ABSTRACT | FULL TEXT  

Pancreatic Cancer: Cost-Effectiveness of Imaging Technologies for Assessing Resectability
McMahon et al.
Radiology 2001;221:93-106.
ABSTRACT | FULL TEXT  

Decreasing Length of Stay After Pancreatoduodenectomy
Brooks et al.
Arch Surg 2000;135:823-830.
ABSTRACT | FULL TEXT  

Comparison of Magnetic Resonance and Endoscopic Retrograde Cholangiopancreatography in Malignant Pancreaticobiliary Obstruction
Georgopoulos et al.
Arch Surg 1999;134:1002-1007.
ABSTRACT | FULL TEXT  

Operative Repair of Bile Duct Injuries Involving the Hepatic Duct Confluence
Jarnagin and Blumgart
Arch Surg 1999;134:769-775.
ABSTRACT | FULL TEXT  

A Refined Approach to the Repair of Postcholecystectomy Bile Duct Strictures
Sutherland et al.
Arch Surg 1999;134:299-302.
ABSTRACT | FULL TEXT