scholarly journals Covered self‐expandable metal stents versus plastic stents for preoperative biliary drainage in patient receiving neo‐adjuvant chemotherapy for borderline resectable pancreatic cancer: a prospective randomized study

2021 ◽  
Author(s):  
Takashi Tamura ◽  
Masahiro Itonaga ◽  
Reiko Ashida ◽  
Yasunobu Yamashita ◽  
Keiichi Hatamaru ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adjuvant Chemotherapy ◽  
Biliary Drainage ◽  
Randomized Study ◽  
Preoperative Biliary Drainage ◽  
Plastic Stents ◽  
Metal Stents ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Neo Adjuvant Chemotherapy

scholarly journals Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Tomofumi Tsuboi ◽  
Tamito Sasaki ◽  
Masahiro Serikawa ◽  
Yasutaka Ishii ◽  
Teruo Mouri ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Metallic Stents ◽  
Plastic Stents ◽  
Complication Rates ◽  
Metallic Stent ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Hospitalization Costs

Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC).Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery.Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p=0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test,p=0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery.Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

scholarly journals Safety and efficacy of self-expanding metal stents for biliary drainage in patients receiving neoadjuvant therapy for pancreatic cancer

2018 ◽  
Vol 06 (06) ◽  
pp. E714-E721 ◽  
Author(s):  
Darren Ballard ◽  
Syed Rahman ◽  
Brian Ginnebaugh ◽  
Abdul Khan ◽  
Kulwinder Dua
Keyword(s):  
Pancreatic Cancer ◽  
Neoadjuvant Therapy ◽  
Biliary Drainage ◽  
Plastic Stents ◽  
Metal Stents ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Safety And Efficacy ◽  
Tertiary Center ◽  
Self Expanding Metal Stents

Abstract Background and study aims Durable biliary drainage is essential during neoadjuvant therapy (NAT) in patients with pancreatic cancer who present with biliary obstruction. Plastic stents (PS) tend to occlude readily, resulting in delay/interruption of treatment. Our aim was to evaluate the safety and efficacy of self-expanding metal stents (SEMS) for biliary drainage in patients receiving NAT for pancreatic cancer. Patients and methods From 2009 to 2014, all consecutive patients with resectable pancreatic cancer at one tertiary center had SEMS placed for biliary drainage before NAT was started. Data on biliary drainage efficacy, stent malfunction rates and procedural adverse events were collected. Results One hundred forty-two consecutive patients with pancreatic cancer (mean age 66 ± 9 SD years; 81 male, 61 female; 67 resectable, 75 borderline resectable) were enrolled. Eight-seven patients (61 %) had prior PS exchanged to SEMS and 55 (39 %) had SEMS placed upfront. Median duration from SEMS placement to the end of NAT/surgery was 111 days (range 44 – 282). During NAT, SEMS malfunction requiring reintervention occurred in 16 patients (11.2 %): tissue ingrowth 11, stent occlusion from food 6, stent migration 3, incomplete expansion 1, “tissue cheese-cutter” effect 1, and cystic duct obstruction 1. On subgroup analysis, no correlation between SEMS malfunction and stage of disease, prior PS, or duration of NAT was found (r2 = 0.05, P = 0.34). Presence of SEMS in situ did not affect pancreaticoduodenectomy. Conclusion SEMS provide safe, effective and durable biliary drainage during NAT for pancreas cancer. Previously placed PS can be exchanged for SEMS. SEMS do not require removal prior to surgery.Meeting presentations: Digestive Disease Week 2015 and 2017

Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer

Gut ◽  
2015 ◽  
Vol 65 (12) ◽  
pp. 1981-1987 ◽  
Author(s):  
J A M G Tol ◽  
J E van Hooft ◽  
R Timmer ◽  
F J G M Kubben ◽  
E van der Harst ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Plastic Stents ◽  
Resectable Pancreatic Cancer

Overall survival with preoperative biliary drainage in patients with resectable pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 314-314
Author(s):  
Tobin Joel Crill Strom ◽  
Sarah E. Hoffe ◽  
Shivakumar Vignesh ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Tumor Size ◽  
Biliary Drainage ◽  
Cox Regression ◽  
Neoadjuvant Treatment ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer ◽  
Pathologic Features

314 Background: Resectable pancreatic cancer patients often present with obstructive jaundice necessitating the placement of biliary stents or percutaneouse drainage catheters. We sought to evaluate whether preoperative biliary drainage affects recurrence and survival. Methods: An IRB-approved study was conducted on our institutional tumor registry to identify pancreatic cancer patients who were treated with upfront surgery between 2000 and 2012. Patients were then stratified by preoperative use of endoscopically placed stents (ERCP), percutaneous catheters (PTC), or no biliary drainage (NBD). The primary endpoint was overall survival (OS). Survival curves were calculated using the Kaplan-Meier method and the log-rank test. Multivariate analysis (MVA) was performed with a Cox regression model. Results: We identified 202 patients for the study (21 PTC; 89 ERCP; 92 NBD). Key differences between the 3 groups were mean pathologic tumor size (p=0.005), pathologic T3/4 (p =0.01), and pathologic N1 (p=0.007) status, with more aggressive pathologic features in PTC patients. PTC patients had a non-significant increase in rate of hepatic recurrences compared with ERCP and NBD patients (47.4% vs. 26.6% vs. 28.7%, respectively; p=0.20). PTC patients also had worse median and 3 year survival (21 months and 16%) compared to ERCP (23.3 months and 39%) and NBD patients (29 months and 45%, p=0.02). MVA revealed that PTC was an independent predictor of worse overall survival (HR 2.3[95% CI 1.3-4.0], p=0.005), along with pathologic tumor size (HR 1.1[1.0-1.3], p=0.008), nodes positive (HR 1.1[1.1-1.2], p=0.001), and post-operative CA19-9 >90 (HR 2.6[1.5-4.4], p=0.001). Conclusions: Patients with resectable pancreatic cancer who require a pre-operative PTC drain had a non-significant increase in hepatic recurrence rate and worse overall survival than patients who either had an ERCP stent placed or no biliary decompression prior to surgery. Given their worse prognosis, patients who require PTC placement might also benefit from neoadjuvant treatment with restaging prior to surgery.

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