Preoperative biliary stenting and major morbidity after pancreatoduodenectomy: Does elapsed time matter? The Fragerita Study Group

Objective: To analyze possible associations between the duration of stent placement before surgery and the occurrence and severity of postoperative complications after pancreatoduodenectomy (PD). Background: The effect of preoperative stent duration on postoperative outcomes after PD has not been investigated. Methods: From 2013 to 2016, patients who underwent PD for any reasons after biliary stent placement at 5 European academic centers were analyzed from prospectively maintained databases. The primary aim was to investigate the association between the duration of preoperative biliary stenting and postoperative morbidity. Patients were stratified by stent duration into 3 groups: short (<4 weeks), intermediate (4–8 weeks), and long (8 weeks). Results: In all, 312 patients were analyzed. The median time from stent placement to surgery was 37 days (2–559 days), and most operations were performed for pancreatic cancer (67.6%). Morbidity and mortality rates were 56.0% and 2.6%, respectively. Patients in the short group (n ¼ 106) experienced a higher rate of major morbidity (43.4% vs 20.0% vs 24.2%; P < 0.001), biliary fistulae (13.2% vs 4.3% vs 5.5%; P ¼ 0.031), and length of hospital stay [16 (10–52) days vs 12 (8–35) days vs 12 (8–43) days; P ¼ 0.025]. A multivariate adjusted model identified the short stent duration as an independent risk factor for major complications (odds ratio 2.64, 95% confidence interval 1.23–5.67, P ¼ 0.013). Conclusions: When jaundice treatment cannot be avoided, delaying surgery up to 1 month after biliary stenting may reduce major morbidity, procedure-related complications, and length of hospital stay.