Is preoperative biliary stenting associated with increased rate of postoperative complications for patients undergoing pancreatoduodenectomy? A review of national surgical quality improvement program data

Background: Jaundice in the setting of periampullary neoplasms is often treated with biliary stenting. Level 1 data demonstrated an increase in perioperative complications after pancreaticoduodenectomy in patients undergoing stent placement. However, the impact of this data on practice patterns in the US remains unknown. Participant Use Data File was used to identify patients from 2014 to 2017 undergoing pancreatoduodenectomy. Chi-square test and multivariable logistic regression were used to compare outcomes between those with biliary stent and those without.Results: Of the 5524 patients, 3321 (60.1%) had biliary stent placement. The stent group was older, had a higher ASA class, and had preoperative weight loss compared to the group without biliary stenting (all p < 0.05). When adjusting for demographic and operative characteristics, the non-stent group had lower associated overall complications and postoperative infections. There was no significant difference in mortality and pancreatic fistula rate between groups.Conclusion: Preoperative biliary stenting is still common prior to pancreaticoduodenectomy. With a trend toward increased utilization of neoadjuvant chemotherapy, stenting will likely remain a common practice. Recognition of increased rates of complications associated with stent placement allows for appropriate risk-benefit analysis.

Automated summary

Background: Jaundice in periampullary neoplasms is often treated with biliary stenting. Level 1 data showed increased complications after pancreaticoduodenectomy in patients with stents. This study analyzed US patient data and found that preoperative biliary stenting is still common, but the non-stent group had lower overall complications and postoperative infections. There was no significant difference in mortality and pancreatic fistula rate between groups. Conclusion: Despite the increased risk of complications, biliary stenting will likely remain common practice due to the trend of increased utilization of neoadjuvant chemotherapy.