148 Biliary Self Expandable Metal Stents Do Not Increase Overall Complications in Patients Undergoing Pancreaticoduodenectomy

Biliary Self Expandable Metal Stents Do Not Increase Overall Complications in Patients Undergoing Pancreaticoduodenectomy Lianne K. Cavell*, Cjloe R. Vinoya, Peter J. Allen, Anne Eaton, Mithat Gonen, Hans Gerdes, Robin B. Mendelsohn, Michael D’Angelica, T. P. Kingham, Yuman Fong, Ronald P. Dematteo, William R. Jarnagin, Robert C. Kurtz, Mark a. Schattner Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY; Department of Biostatistics and Epidemiology, Memorial SloanKettering Cancer Center, New York, NY Background: Recent studies have shown that routine biliary stenting prior to pancreaticoduodenectomy (PD) is not indicated. However, if the bilirubin is markedly elevated, the patient is symptomatic, or surgery needs to be delayed to optimize medical comorbidities or to administer neoadjuvant therapy, preoperative biliary drainage may still be required. Biliary self expandable metal stents (SEMS) provide faster relief of jaundice and more durable patency than plastic stents. Stent durability is crucial to minimize the risk of cholangitis which could delay resection or interrupt neoadjuvant treatment. Concerns persist that SEMS may result in a more difficult resection, increased operative complications, and decreased R0 resection rate. The aim of this study was to compare surgical outcomes of patients undergoing PD with SEMS in place versus plastic endoscopic stent (PES) and no stent (NS). Methods: We reviewed a prospectively maintained database which included all patients who underwent PD at Memorial Sloan-Kettering Cancer Center between March 2008 and July 2011. Patients were included if they had a successful resection and were 18 years or older, and excluded if had percutaneous biliary drainage. Abstracted data included demographics, presence of biliary stent, operative details, peri-operative complications, and pathology. Each postoperative complication was graded on a previously validated severity scale from 1 to 5, with 5 being highest severity. Medical records were reviewed to determine the type of biliary stent. Patients were categorized as either NS, SEMS, or PES. These groups were compared using Fisher’s exact test for categorical covariates and ANOVA for continuous covariates. Results: Among 513 patients who underwent PD, 72 patients had SEMS, 150 had a PES, and 291 had NS. There were no statistically significant differences in gender or pre-operative ASA (American Society of Anesthesiologists) class between SEMS and NS, but there were more ASA class 3 or 4 in the SEMS group compared to the PES group. Patients with either stent tended to be older and more likely to have adenocarcinoma. There were no differences between the three groups in regards to R0 resection rate, length of stay, all postoperative complications, biliary anastomotic leak, or 30 day mortality. In the SEMS group there was an increase in wound infection and operative time compared to the PES and NS groups, and a small yet statistically significant increase in estimated blood loss between the SEMS and NS groups. Conclusion: This study suggests that the use of preoperative SEMS in patients undergoing PD does not compromise R0 resection rate, increase overall postoperative complications, or increase length of stay, but does result in more postoperative wound infections and longer operative time.