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A Comparison Between Plastic and Metallic Biliary Stent Placement in Patients Receiving Preoperative Neoadjuvant Chemoradiotherapy for Resectable Pancreatic Cancer

  • Kota Nakamura
  • Masayuki Sho
  • Takahiro Akahori
  • Minako Nagai
  • Satoshi Nishiwada
  • Kenji Nakagawa
  • Toshihiro Tanaka
  • Kimihiko Kichikawa
  • Tetsuro Tamamoto
  • Masatoshi Hasegawa
  • Akira Mitoro
  • Hitoshi Yoshiji
  • Naoya Ikeda
Original Scientific Report (including Papers Presented at Surgical Conferences)
  • 63 Downloads

Abstract

Background

The optimal stent type in patients receiving preoperative neoadjuvant chemoradiotherapy (NACRT) is uncertain. The present study aimed to compare the clinical effectiveness of biliary metallic stent (MS) and plastic stent (PS) in patients undergoing preoperative NACRT for resectable pancreatic cancer.

Methods

This retrospective study included 43 patients who required either biliary MS or PS before initiating NACRT for resectable or borderline resectable pancreatic head cancer. Seventeen patients had MS (MS group), while 23 patients had PS (PS group). All patients received preoperative NACRT, including gemcitabine and concomitant three-dimensional radiation of 54 Gy, and underwent pancreatectomy. Stent patency, surgery postponement, postoperative outcomes, and cost-effectiveness were compared between these groups.

Results

There were no significant differences in baseline demographic or tumor characteristics between the groups. Stent patency was significantly longer in the MS group than in the PS group (p = 0.042). There were no differences in time to surgery, intraoperative characteristics, surgical complications, margin positivity, and pathological response between the groups. Furthermore, the medical cost of maintenance of biliary drainage during NACRT was similar between the groups.

Conclusions

MS placement compared to PS in patients receiving preoperative NACRT provided no significant benefits during the postoperative course of pancreatectomy. However, MS placement was associated with long stent patency while showing no economic disadvantage. Therefore, MS placement may be recommended in patients receiving preoperative NACRT for resectable pancreatic cancer.

Notes

Compliance with ethical standards

Conflict of interest

Authors Nakamura, Sho, Akahori, Nagai, Nishiwada, Nakagawa, Tanaka, Kichikawa, Tamamoto, Hasegawa, Mitoro, Yoshiji, and Ikeda have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Traverso LW (2006) Pancreatic cancer: surgery alone is not sufficient. Surg Endosc 20:S446–S449CrossRefGoogle Scholar
  2. 2.
    Schnelldorfer T, Ware AL, Sarr MG et al (2008) Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma. Ann Surg 247:456–462CrossRefGoogle Scholar
  3. 3.
    Ferrone CR, Brennan MF, Gonen M et al (2008) Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg 12:701–706CrossRefGoogle Scholar
  4. 4.
    Chun YS, Milestone BN, Watson JC et al (2010) Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol 17:2832–2838CrossRefGoogle Scholar
  5. 5.
    Laurence JM, Tran PD, Morarji K et al (2011) A systematic review and meta-analysis of survival and surgical outcomes following neoadjuvant chemoradiotherapy for pancreatic cancer. J Gastrointest Surg 15:2059–2069CrossRefGoogle Scholar
  6. 6.
    Andriulli A, Festa V, Botteri E et al (2012) Neoadjuvant/preoperative gemcitabine for patients with localized pancreatic cancer: a meta-analysis of prospective studies. Ann Surg Oncol 19:1644–1662CrossRefGoogle Scholar
  7. 7.
    Katz MHG, Wang H, Balachandran A et al (2012) Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg 16:68–79CrossRefGoogle Scholar
  8. 8.
    Papalezova KT, Tyler DS, Blazer DG et al (2012) Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer? J Surg Oncol 106:111–118CrossRefGoogle Scholar
  9. 9.
    Niels AVDG, Erik AJR, Casper HJVE et al (2010) Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med 362:129–137CrossRefGoogle Scholar
  10. 10.
    Davids PHP, Groen AK, Rauws EAJ et al (1992) Randomised trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 340:1488–1492CrossRefGoogle Scholar
  11. 11.
    Lammer J, Hausegger KA, Flückiger F et al (1996) Common bile duct obstruction due to malignancy: treatment with plastic versus metal stents. Radiology 201:167–172CrossRefGoogle Scholar
  12. 12.
    Soderlund C, Linder S (2006) Covered metal versus plastic stents for malignant common bile duct stenosis: a prospective, randomized, controlled trial. Gastrointest Endosc 63:986–995CrossRefGoogle Scholar
  13. 13.
    Isayama H, Yasuda I, Ryozawa S et al (2011) Results of a Japanese multicenter, randomized trial of endoscopic stenting for non-resectable pancreatic head cancer (JM-TEST): covered wallstent versus doublelayer stent. Dig Endosc 23:310–315CrossRefGoogle Scholar
  14. 14.
    Moses PL, Alnaamani KM, Barkun AN et al (2013) Randomized trial in malignant biliary obstruction: plastic vs partially covered metal stents. World J Gastroenterol 19:8638–8646CrossRefGoogle Scholar
  15. 15.
    Almadi MA, Barkun A, Martel M (2017) Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol 112:260–273CrossRefGoogle Scholar
  16. 16.
    Wasan SM, Ross WA, Staerkel GA, Lee JH (2005) Use of expandable metallic biliary stents in resectable pancreatic cancer. Am J Gastroenterol 100:2056–2061CrossRefGoogle Scholar
  17. 17.
    Mullen JT, Lee JH, Gomez HF et al (2005) Pancreaticoduodenectomy after placement of endobiliary metal stents. J Gastrointest Surg 9:1094–1105CrossRefGoogle Scholar
  18. 18.
    Kubota K, Sato T, Watanabe S et al (2014) Covered self-expandable metal stent deployment promises safe neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic head cancer. Dig Endosc 26:77–86CrossRefGoogle Scholar
  19. 19.
    Gardner TB, Spangler CC, Byanova KL et al (2016) Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial. Gastrointest Endosc 84:460–466CrossRefGoogle Scholar
  20. 20.
    Sho M, Akahori T, Tanaka T et al (2013) Pathological and clinical impact of neoadjuvant chemoradiotherapy using full-dose gemcitabine and concurrent radiation for resectable pancreatic cancer. J Hepatobiliary Pancreat Sci 20:197–205CrossRefGoogle Scholar
  21. 21.
    Sho M, Akahori T, Tanaka T et al (2015) Optimal indication of neoadjuvant chemoradiotherapy for pancreatic cancer. Langenbeck’s Arch Surg 400:477–485CrossRefGoogle Scholar
  22. 22.
    Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Liss, New YorkGoogle Scholar
  23. 23.
    Edge SB, Compton CC (2010) The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 17:1471–1474CrossRefGoogle Scholar
  24. 24.
    Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications. Ann Surg 240:205–213CrossRefGoogle Scholar
  25. 25.
    Bassi C, Dervenis C, Butturini G et al (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefGoogle Scholar
  26. 26.
    Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH)-an international study group of pancreatic surgery (ISGPS) definition. Surgery 142:20–25CrossRefGoogle Scholar
  27. 27.
    Boulay BR, Gardner TB, Gordon SR (2010) Occlusion rate and complications of plastic biliary stent placement in patients undergoing neoadjuvant chemoradiotherapy for pancreatic cancer with malignant biliary obstruction. J Clin Gastroenterol 44:452–455PubMedGoogle Scholar
  28. 28.
    Aadam AA, Evans DB, Khan A et al (2012) Efficacy and safety of self-expandable metal stents for biliary decompression in patients receiving neoadjuvant therapy for pancreatic cancer: a prospective study. Gastrointest Endosc 76:67–75CrossRefGoogle Scholar
  29. 29.
    Tol JA, van Hooft JE, Timmer R et al (2015) Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut 65:1981–1987CrossRefGoogle Scholar
  30. 30.
    Prat F, Chapat O, Ducot B et al (1998) Predictive factors for survival of patients with inoperable malignant distal biliary strictures: a practical management guidelines. Gut 42:76–80CrossRefGoogle Scholar
  31. 31.
    Prat F, Chapat O, Ducot B et al (1998) A randomized trial of endoscopic drainage methods for inoperable malignant strictures of the common bile duct. Gastrointest Endosc 47:1–7CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Kota Nakamura
    • 1
  • Masayuki Sho
    • 1
  • Takahiro Akahori
    • 1
  • Minako Nagai
    • 1
  • Satoshi Nishiwada
    • 1
  • Kenji Nakagawa
    • 1
  • Toshihiro Tanaka
    • 2
  • Kimihiko Kichikawa
    • 2
  • Tetsuro Tamamoto
    • 3
  • Masatoshi Hasegawa
    • 3
  • Akira Mitoro
    • 4
  • Hitoshi Yoshiji
    • 4
  • Naoya Ikeda
    • 1
  1. 1.Department of SurgeryNara Medical UniversityKashiharaJapan
  2. 2.Department of RadiologyNara Medical UniversityKashiharaJapan
  3. 3.Department of Radiation OncologyNara Medical UniversityKashiharaJapan
  4. 4.Third Department of Internal MedicineNara Medical UniversityKashiharaJapan

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