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

Abstract：

INTRODUCTION:In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. METHODS:A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. RESULTS:53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. CONCLUSIONS:For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. TRIAL REGISTRATION NUMBER:Dutch Trial Registry (NTR3142).

journal_name

Gut

journal_title

Gut

authors

Tol JA,van Hooft JE,Timmer R,Kubben FJ,van der Harst E,de Hingh IH,Vleggaar FP,Molenaar IQ,Keulemans YC,Boerma D,Bruno MJ,Schoon EJ,van der Gaag NA,Besselink MG,Fockens P,van Gulik TM,Rauws EA,Busch OR,Gouma DJ

doi

10.1136/gutjnl-2014-308762

subject

Has Abstract

pub_date

2016-12-01 00:00:00

pages

1981-1987

issue

12

eissn

0017-5749

issn

1468-3288

pii

gutjnl-2014-308762

journal_volume

65

pub_type

杂志文章,多中心研究

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