Pancreaticoduodenectomy after placement of endobiliary metal stents |
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Authors: | John T Mullen MD Jeffrey H Lee MD Henry F Gomez MD William A Ross MD Norio Fukami MD Robert A Wolff MD Eddie K Abdalla MD Jean-Nicolas Vauthey MD Jeffrey E Lee MD Peter W T Pisters MD Douglas B Evans MD |
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Institution: | (1) Pancreatic Cancer Study Group: Departments of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas;(2) Gastroenterology and Nutrition, The University of Texas M. D. Anderson Cancer Center, Houston, Texas;(3) Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas;(4) Department of Surgical Oncology, Unit 444, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, 77030 Houston, TX |
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Abstract: | Contemporary treatment programs for patients with potentially resectable pancreatic cancer often involve preoperative therapy.
When the duration of preoperative therapy exceeds 2 months, the risk of plastic endobiliary stent occlusion increases. Metal
stents have much better patency but may complicate subsequent pancreaticoduodenectomy (PD). We evaluated rates of perioperative
morbidity, mortality, and stent complications in 272 consecutive patients who underwent PD at our institution from May 2001
to November 2004. Of these 272 patients, 29 (11%) underwent PD after placement of a metal stent, 141 underwent PD after placement
of a plastic stent, 10 had PD after biliary bypass without stenting, and 92 had PD without any form of biliary decompression.
No differences were found between the Metal Stent group and all other patients in median operative time, intraoperative blood
loss, or length of hospital stay. No perioperative deaths occurred in the Metal Stent group versus 3 (1.2%) deaths in the
other 243 patients. The incidence of major perioperative complications was similar between the two groups, including the rates
of pancreatic fistula, intra-abdominal abscess, and wound infection. Furthermore, there were no differences in the perioperative
morbidity or mortality rates between patients who underwent preoperative biliary decompression with a stent of any kind (metal
or plastic) and those patients who underwent no biliary decompression at all. Metal stent-related complications occurred in
2 (7%) of 29 patients during a median preoperative interval of 4.1 months; in contrast, 75 (45%) of the 166 patients who had
had plastic stents experienced complications, including 98 stent occlusions, during a median preoperative interval of 3.9
months (P < 0.001). We conclude that the use of expandable metal stents does not increase PD-associated perioperative morbidity
or mortality, and as such an expandable metal stent is our preferred method of biliary decompression in patients with symptomatic
malignant distal bile duct obstruction in whom surgery is not anticipated, or in whom there is a significant delay in the
time to surgery.
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18,
2005 (oral presentation).
Supported by the Lockton Fund for Pancreatic Cancer Research, The University of Texas M. D. Anderson Cancer Center, Houston,
Texas. |
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Keywords: | Pancreaticoduodenectomy metal stent biliary decompression |
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