Impact of preoperative self-expandable metal stent on benign hepaticojejunostomy anastomotic stricture after pancreaticoduodenectomy.

Autor: Mie T; Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Sasaki T; Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Kobayashi K; Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Takeda T; Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Okamoto T; Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Kasuga A; Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Inoue Y; Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Takahashi Y; Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan., Saiura A; Division of Hepatobiliary and Pancreatic Surgery Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.; Department of Hepatobiliary and Pancreatic Surgery Juntendo University School of Medicine Tokyo Japan., Sasahira N; Department of Hepato-Biliary-Pancreatic Medicine Cancer Institute Hospital, Japanese Foundation for Cancer Research Tokyo Japan.
Jazyk: angličtina
Zdroj: DEN open [DEN Open] 2023 Oct 28; Vol. 4 (1), pp. e307. Date of Electronic Publication: 2023 Oct 28 (Print Publication: 2024).
DOI: 10.1002/deo2.307
Abstrakt: Objectives: Hepaticojejunostomy anastomotic stricture (HJAS) is a serious adverse event of pancreaticoduodenectomy. Preoperative biliary drainage with a self-expandable metal stent (SEMS) is often performed before pancreaticoduodenectomy. The purpose of this study is to evaluate the risk factors and impact of preoperative SEMS placement on developing benign HJAS after pancreaticoduodenectomy.
Methods: We retrospectively analyzed consecutive patients who underwent pancreatoduodenectomy at our institution between July 2014 and June 2020. Risk factors for benign HJAS were identified using univariate and multivariate logistic regression analysis. We also compared outcomes of preoperative biliary drainage using SEMS and non-SEMS.
Results: Of the 626 included patients, benign HJAS occurred in 36 patients (5.8%). The median follow-up time was 36.7 months (interquartile range, 25.4-57.4 months). Multivariate logistic regression analysis revealed that lack of preoperative biliary drainage, preoperative bile duct diameter <5 mm, and former or current smoking were independent predictors of benign HJAS. In the preoperative biliary drainage group, the rate of preoperative bile duct diameter <5 mm was significantly lower in the SEMS group than in the non-SEMS group (2.0% vs. 12.8%, p = 0.04).
Conclusions: Preoperative biliary drainage with SEMS may be useful to maintain bile duct diameter ≥5 mm and to reduce benign HJAS as a result.
Competing Interests: None.
(© 2023 The Authors. DEN Open published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)
Databáze: MEDLINE
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