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Contemporary analysis of complications associated with biliary stents during neoadjuvant therapy for pancreatic adenocarcinoma. HPB (Oxford) 2019 Jun;21(6):662-668

Date

12/14/2018

Pubmed ID

30522947

DOI

10.1016/j.hpb.2018.10.009

Scopus ID

2-s2.0-85057561087 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: With the increasing use of biliary stents for neoadjuvant therapy (NT) for pancreatic adenocarcinoma (PDAC), the risk of post-pancreaticoduodenectomy (PD) infection remains relevant. This study documents the contemporary incidence of stent-related complications (SRC) during NT and to analyze their impact on surgical infections.

METHODS: Consecutive patients from a single institution (2011-15) with resected PDAC treated with biliary decompression, NT, and PD were analyzed. Stent-related complications (SRC) were compared among patients with/without prospectively documented composite pre- and post-operative infections (surgical site infection [SSI], organ space infection [OSI], and cholangitis).

RESULTS: Of 114 total patients, (median 164 days, initial stent to surgery), 95% had initial endoscopic (vs. percutaneous) stenting. Initial stents were often plastic (80/114, 70%), with 43/114 (38%) undergoing routine exchange to metal stent before NT. Fifteen (13%) patients had stent cholangitis during NT requiring antibiotics and/or stent exchange. There were 33/114 (29%) patients with SRC, requiring 66 exchanges. Post-PD rates of SSI, OSI, and cholangitis were 23%, 5%, and 4%, respectively [composite rate 30%]. On multivariate analysis, SRC were not associated with composite surgical infections (p > 0.05).

CONCLUSIONS: Although SRC occurred in almost one-third of PDAC patients during NT, with appropriate intervention, there was no association with increased surgical infections.

Author List

Kim BJ, Prakash L, Narula N, Davis CH, Kim MP, Aloia TA, Vauthey JN, Lee JE, Katz MH, Tzeng CD

Author

Carley Davis MD Professor in the Urologic Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adenocarcinoma
Adult
Aged
Aged, 80 and over
Bile Ducts
Cholangiopancreatography, Endoscopic Retrograde
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Neoadjuvant Therapy
Pancreatic Neoplasms
Pancreaticoduodenectomy
Prognosis
Prosthesis-Related Infections
Retrospective Studies
Stents
Texas