A PREOPERATIVE BILIARY STENT IS ASSOCIATED WITH INCREASED COMPLICATIONS AFTER PANCREATICODUODENECTOMY

Background: A preoperative biliary stent is commonly used after the in itial evaluation of the patient with a periampullary mass. Objective: To evaluate the effect of a preoperative biliary stent on operative di fficulty, postoperative complications, and length of hospital stay aft er a pancreatoduodenectomy. Design: A retrospective review of a prospe ctively collected consecutive series. Setting: The Memorial Sloan-Kett ering Cancer Center's Surgical Service, New York, NY. Patients and Met hods: Seventy-four patients underwent pancreatoduodenectomy between Ma rch 1, 1994, and February 15, 1996. Thirty-five did not receive a bili ary stent, and 39 received a biliary stent prior to medical evaluation . We analyzed patient, nutritional, laboratory, and operating room fac tors. Univariate analysis was by Student t test, chi(2) test, and Fish er exact test; multivariate analysis was by logistic regression. Signi ficance was defined at P < .05. Main Outcome Measures: Operative time, amount of blood loss, complications, and length of hospital stay. Wou nd complications were defined as cellulitis, superficial infections, a nd deep infections. Intra-abdominal complications were defined as intr a-abdominal abscesses and pancreatic or biliary fistula. Results: Grou ps were equivalent for tumor size, risk of comorbidity, time spent in the operating room, and amount of blood loss. There was 1 perioperativ e death. Patients with a stent had significantly lower bilirubin (P < .03) and aspartate aminotransferase (P < .04) levels and a significant ly increased risk of nodal positivity (P < .05). The patients with a b iliary stent had an increased risk of wound or abdominal complications on univariate (P < .003) and multivariate (P < .02) analysis and tend ed toward a prolonged hospital stay (P < .04, Wilcoxon signed rank tes t). Conclusions: A preoperative biliary stent was associated with an i ncreased risk of wound or intraabdominal complications; a stent may pr olong the length of hospital stay. However, length of time under anest hesia, amount of blood loss, and transfusion requirements were not alt ered. A biliary stent should be used with a high degree of selectivity in the management of patients with resectable periampullary masses.