Does pre-operative stenting affect post-operative outcome in peri-ampullary carcinoma?

Abstract

Background: Pre-operative biliary stenting in patients undergoing surgery for peri-ampullary malignancy has been considered to cause technical difficulty during surgery due to local inflammatory response, post-operative infective complications leading to morbidity and mortality. The aim of this study was to compare the early outcomes of patients undergoing pre-operative stenting versus non-stented patients. Materials & Methods: This was a retrospective observational study of patients undergoing surgery for peri-ampullary malignancy in a tertiary medical college & hospital from January 2015 to October 2018. The patients were divided into two groups: those stented pre-operatively (cases) and those not stented pre-operatively (controls). They were compared (matched) for age, type of surgery – curative (pancreaticoduodenectomy) or palliative (double or triple bypass), pre-operative haemoglobin, bilirubin and albumin. The outcome measures were duration of surgery, number of transfusions, post-operative fall of haemoglobin, post-operative complications (anastomotic leak), duration of ICU and hospital stay and in-hospital mortality. Results: Records of 41 patients could be retrieved. There were 26 non-stented and 15 stented patients. Both the groups were comparable for age, type of surgery, pre-op bilirubin, haemoglobin and albumin levels. The stented group had zero in-hospital mortality versus non-stented group with 30.76 percent mortality (p value 0.018). The anastomotic leak and post-operative infective complications were lower in the stented group (not statistically significant). The duration of surgery, number of blood transfusions, post-operative fall of haemoglobin, duration of ICU stay and hospital stay were not higher in the stented group. Conclusion: Unlike the published western literature which reports higher anastomotic leak rates and infective complications among stented patients, among Indian patients pre-operative stenting seems to have a survival advantage. This may be due to beneficial effect of stenting in correcting physiological disturbances caused by obstructive jaundice.