Pre-operative stenting and complications following pancreatoduodenectomy for pancreatic cancer: an analysis of the ACS-N
- PDF / 785,563 Bytes
- 8 Pages / 595.276 x 790.866 pts Page_size
- 95 Downloads / 177 Views
and Other Interventional Techniques
Pre‑operative stenting and complications following pancreatoduodenectomy for pancreatic cancer: an analysis of the ACS‑NSQIP registry Carlos Garcia‑Ochoa1,4,5 · Eric McArthur2 · Anton Skaro1,3 · Ken Leslie1 · Jeff Hawel1 Received: 31 March 2020 / Accepted: 15 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Historically, pre-operative biliary stenting has been associated with higher infectious complication rates following pancreatoduodenectomy. However, alleviation of biliary obstruction is necessary for consideration of pre-operative chemotherapy, which may improve disease-free survival, or for mitigation of symptoms while awaiting surgery. Our aim is to compare contemporary post-operative complication risk among patients with pre-operative endoscopic retrograde cholangiopancreatography (ERCP) stenting compared to those without. Methods Patients who underwent a pancreatoduodenectomy for pancreatic cancer with biliary obstruction within the ACSNSQIP registry from 2014 to 2017 were identified. The primary outcome was to compare the risk of 30-day complication (composite outcome) between patients with and without pre-operative ERCP stenting. Propensity score matching was used to ensure balanced baseline characteristics and log-binomial regression models were used to estimate risk ratios for overall perioperative complication between groups. Results From 6073 patients with obstructive jaundice undergoing pancreatoduodenectomy for pancreatic cancer, 92% (5564) were eligible for the study. After performing a propensity score matching on 20 baseline characteristics, 952 patients without stenting were matched to up to four patients who received pre-operative ERCP stenting (n = 3467) for a matched cohort of 4419. A total of 1901 (55%) patients with pre-operative ERCP stenting experienced a post-operative complication compared to 501 (53%) patients without stenting (risk ratio 1.04, 95% CI 0.97–1.11, p = 0.23). Conclusion Pre-operative ERCP stenting was not associated with an increased risk of post-operative complication in patients undergoing pancreatoduodenectomy with obstructive jaundice. Biliary stenting may be safely considered for symptom relief and to potentially facilitate pre-operative chemotherapy for pancreatic cancer. Keywords ERCP · Stent · Complication · Whipple · Pancreatic cancer · Pancreatoduodenectomy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08160-9) contains supplementary material, which is available to authorized users. * Carlos Garcia‑Ochoa [email protected] 1
Department of General Surgery, London Health Sciences Centre, London, ON, Canada
2
IC/ES, Toronto, ON, Canada
3
Department of Liver Transplantation, London Health Sciences Centre, London, ON, Canada
4
Present Address: Department of General Surgery, University of Ottawa, Ottawa, ON, Canada
5
Victoria Hospital, London Health Sciences Centre, 800 Commissioners Road East Roo
Data Loading...
