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

Published:January 24, 2022DOI:



      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.


      The National Surgical Quality Improvement Program (NSQIP) Pancreatectomy Targeted 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.


      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.


      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.
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        • Garcea G.
        • Ong S.L.
        • Dennison A.R.
        • Berry D.P.
        • Maddern G.J.
        Palliation of malignant obstructive jaundice.
        Dig Dis Sci. 2009; 54: 1184-1198
        • Pavlidis E.T.
        • Pavlidis T.E.
        Pathophysiological consequences of obstructive jaundice and perioperative management.
        Hepatobiliary Pancreat Dis Int. 2018; 17: 17-21
        • Moole H.
        • Bechtold M.
        • Puli S.R.
        Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review.
        World J Surg Oncol. 2016; 14: 182
        • van der Gaag N.A.
        • Rauws E.A.
        • van Eijck C.H.
        • Bruno M.J.
        • van der Harst E.
        • Kubben F.J.
        • et al.
        Preoperative biliary drainage for cancer of the head of the pancreas.
        N Engl J Med. 2010; 362: 129-137
        • Scheufele F.
        • Schorn S.
        • Demir I.E.
        • Sargut M.
        • Tieftrunk E.
        • Calavrezos L.
        • et al.
        Preoperative biliary stenting versus operation first in jaundiced patients due to malignant lesions in the pancreatic head: a meta-analysis of current literature.
        Surgery. 2017; 161: 939-950
        • Bhatti A.B.H.
        • Jafri R.Z.
        • Khan M.K.
        • Dar F.S.
        Preoperative endoscopic biliary stenting before pancreaticoduodenectomy: does timing matter?.
        Surg Innovat. 2020; : 567-572
        • Bassi C.
        • Marchegiani G.
        • Dervenis C.
        • Sarr M.
        • Abu Hilal M.
        • Adham M.
        • et al.
        The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years after.
        Surgery. 2017; 161: 584-591
        • Jinkins L.J.
        • Parmar A.D.
        • Han Y.
        • Duncan C.B.
        • Sheffield K.M.
        • Brown K.M.
        • et al.
        Current trends in preoperative biliary stenting in patients with pancreatic cancer.
        Surgery. 2013; 154: 179-189
        • Cortes A.
        • Sauvanet A.
        • Bert F.
        • Janny S.
        • Sockeel P.
        • Kianmanesh R.
        • et al.
        Effect of bile contamination on immediate outcomes after pancreaticoduodenectomy for tumor.
        J Am Coll Surg. 2006; 202: 93-99
        • Coates J.M.
        • Beal S.H.
        • Russo J.E.
        • Vanderveen K.A.
        • Chen S.L.
        • Bold R.J.
        • et al.
        Negligible effect of selective preoperative biliary drainage on perioperative resuscitation, morbidity, and mortality in patients undergoing pancreaticoduodenectomy.
        Arch Surg. 2009; 144: 841-847
        • Brajcich B.C.
        • Ko C.Y.
        • Liu J.B.
        • Ellis R.J.
        • D Angelica M.I.
        A NSQIP-based randomized clinical trial evaluating choice of prophylactic antibiotics for pancreaticoduodenectomy.
        J Surg Oncol. 2021; 123: 1387-1394
        • Son J.H.
        • Kim J.
        • Lee S.H.
        • Hwang J.H.
        • Ryu J.K.
        • Kim Y.T.
        • et al.
        The optimal duration of preoperative biliary drainage for periampullary tumors that cause severe obstructive jaundice.
        Am J Surg. 2013; 206: 40-46
        • Dumonceau J.M.
        • Tringali A.
        • Papanikolaou I.S.
        • Blero D.
        • Mangiavillano B.
        • Schmidt A.
        • et al.
        Endoscopic biliary stenting: indications, choice of stents, and results: European society of gastrointestinal endoscopy (ESGE) clinical guideline - updated October 2017.
        Endoscopy. 2018; 50: 910-930
        • Hashmi A.
        • Kozick Z.
        • Fluck M.
        • Hunsinger M.A.
        • Wild J.
        • Arora T.K.
        • et al.
        Am Surg. 2018; 84: 1439-1445
        • Cooper A.B.
        • Parmar A.D.
        • Riall T.S.
        • Hall B.L.
        • Katz M.H.
        • Aloia T.A.
        • et al.
        Does the use of neoadjuvant therapy for pancreatic adenocarcinoma increase postoperative morbidity and mortality rates?.
        J Gastrointest Surg. 2015; 19 (discussion 6-7): 80-86
        • Kim B.J.
        • Prakash L.
        • Narula N.
        • Davis C.H.
        • Kim M.P.
        • Aloia T.A.
        • et al.
        Contemporary analysis of complications associated with biliary stents during neoadjuvant therapy for pancreatic adenocarcinoma.
        HPB. 2019; 21: 662-668