TY - JOUR
T1 - Contemporary analysis of complications associated with biliary stents during neoadjuvant therapy for pancreatic adenocarcinoma
AU - Kim, Bradford J.
AU - Prakash, Laura
AU - Narula, Nisha
AU - Davis, Catherine H.
AU - Kim, Michael P.
AU - Aloia, Thomas A.
AU - Vauthey, Jean Nicolas
AU - Lee, Jeffrey E.
AU - Katz, Matthew H.
AU - Tzeng, Ching Wei D.
N1 - Publisher Copyright:
© 2018 International Hepato-Pancreato-Biliary Association Inc.
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
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U2 - 10.1016/j.hpb.2018.10.009
DO - 10.1016/j.hpb.2018.10.009
M3 - Article
C2 - 30522947
AN - SCOPUS:85057561087
SN - 1365-182X
VL - 21
SP - 662
EP - 668
JO - HPB
JF - HPB
IS - 6
ER -