Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
HPB (Oxford). 2019 Jun;21(6):662-668. doi: 10.1016/j.hpb.2018.10.009. Epub 2018 Dec 3.
With the increasing use of biliary stents for neoadjuvant therapy (NT) for pancreatic adenocarcinoma (PDAC), the risk of post-pancreaticoduodenectomy (PD) infection remains relevant. This study documents the contemporary incidence of stent-related complications (SRC) during NT and to analyze their impact on surgical infections.
Consecutive patients from a single institution (2011-15) with resected PDAC treated with biliary decompression, NT, and PD were analyzed. Stent-related complications (SRC) were compared among patients with/without prospectively documented composite pre- and post-operative infections (surgical site infection [SSI], organ space infection [OSI], and cholangitis).
Of 114 total patients, (median 164 days, initial stent to surgery), 95% had initial endoscopic (vs. percutaneous) stenting. Initial stents were often plastic (80/114, 70%), with 43/114 (38%) undergoing routine exchange to metal stent before NT. Fifteen (13%) patients had stent cholangitis during NT requiring antibiotics and/or stent exchange. There were 33/114 (29%) patients with SRC, requiring 66 exchanges. Post-PD rates of SSI, OSI, and cholangitis were 23%, 5%, and 4%, respectively [composite rate 30%]. On multivariate analysis, SRC were not associated with composite surgical infections (p > 0.05).
Although SRC occurred in almost one-third of PDAC patients during NT, with appropriate intervention, there was no association with increased surgical infections.
随着胆内支架在胰腺癌新辅助治疗（NT）中的应用越来越多，胰十二指肠切除术后（PD）感染的风险仍然存在。本研究记录了 NT 期间支架相关并发症（SRC）的当代发生率，并分析其对手术感染的影响。
对单中心（2011-15 年）连续接受胆道减压、NT 和 PD 治疗的胰腺导管腺癌（PDAC）患者进行分析。比较了有/无前瞻性记录的术前和术后复合感染（手术部位感染[SSI]、器官间隙感染[OSI]和胆管炎）患者的支架相关并发症（SRC）。
114 例患者中（中位 164 天，初始支架至手术），95%接受了初始内镜（而非经皮）支架置入。初始支架通常为塑料（80/114，70%），43/114（38%）在 NT 前常规更换为金属支架。15 例（13%）患者在 NT 期间发生支架胆管炎，需要使用抗生素和/或更换支架。有 33/114（29%）例患者发生 SRC，需要进行 66 次更换。PD 后 SSI、OSI 和胆管炎的发生率分别为 23%、5%和 4%，复合发生率为 30%。多变量分析显示，SRC 与复合手术感染无关（p>0.05）。
尽管在 NT 期间，几乎三分之一的 PDAC 患者发生 SRC，但通过适当干预，与手术感染增加无关。
