Skip to main content

Advertisement

Log in

Self-Expanding Metal Stents for Biliary Drainage in Patients with Resectable Pancreatic Cancer: Single-Center Experience with 79 Cases

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Background and Aims

To study pre-operative and peri-operative course and outcome on follow up after pancreaticoduodenenctomy (PD) for resectable pancreatic cancer amongst patients receiving self-expanding metal stents (SEMS).

Methods

Medical charts of consecutively reviewed patients (2005–2009) with resectable pancreatic cancer and SEMS placement before PD at the MD Anderson Cancer Center (MDACC) were studied.

Results

Seventy-nine patients (mean age, 68 ± 9 years; 54% males) undergoing PD after SEMS placement were analyzed. Of these, 70% (55/79) had come with previous plastic stents placed within a median of 29 (5–216) days because of presentation and most (95%) underwent neoadjuvant chemoradiation after SEMS placement. The median interval between SEMS placement and PD was 120 (range 28–306) days. There were no technical difficulties during PD. The resected tumor was stage T3 in 72 patients, positive node in 44, lymphovascular invasion in 47, and perineural invasion in 62. Within 30 days after surgery, 26 (33%) patients developed complications requiring intervention, but none died. During a median follow-up of 349 (14–1,508) days after surgery, 32 (41%) patients developed metastatic disease, and 20 (25%) died; median survival was approximately 3 years. Development of metastatic disease during follow-up independently predicted survival with hazard ratio of 16 (95% CI: 4–68; P = 0.0001).

Conclusions

Contrary to the tendency of avoiding the use of metal stents for biliary decompression amongst patients with resectable pancreatic cancer, our study demonstrated that SEMS did not adversely affect surgical technique, postoperative course, or long-term outcome. Therefore, metal stents should be considered for patients with resectable pancreatic cancer who will undergo preoperative chemoradiation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Pierantoni C, Pagliacci A, Scartozzi M, Berardi R, Bianconi M, Cascinu S. Pancreatic cancer: progress in cancer therapy. Crit Rev Oncol Hematol. 2008;67:27–38.

    Article  PubMed  Google Scholar 

  2. Hidalgo M. Pancreatic cancer. N Engl J Med. 2010;362:1605–1617.

    Article  PubMed  CAS  Google Scholar 

  3. Guturu P, Shah V, Urrutia R. Interplay of tumor microenvironment cell types with parenchymal cells in pancreatic cancer development and therapeutic implications. J Gastrointest Cancer. 2009;40:1–9.

    Article  PubMed  Google Scholar 

  4. Whipple AO, Parsons WV, Mullin CR. Treatment of carcinoma of the ampulla of Vater. Ann Surg. 1935;102:763–779.

    Article  PubMed  CAS  Google Scholar 

  5. Abrams RA, Lowy AM, O’Reilly EM, Wolff RA, Picozzi VJ, Pisters PW. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1751–1756.

    Article  PubMed  Google Scholar 

  6. Lowy AM. Neoadjuvant therapy for pancreatic cancer. J Gastrointest Surg. 2008;12:1600–1608.

    Article  PubMed  Google Scholar 

  7. Evans DB, Wolff RA, Crane CH. Neoadjuvant strategies for pancreatic cancer. Oncology (Williston Park). 2001;15:727–737.

    CAS  Google Scholar 

  8. Greer SE, Pipas JM, Sutton JE, et al. Effect of neoadjuvant therapy on local recurrence after resection of pancreatic adenocarcinoma. J Am Coll Surg. 2008;206:451–457.

    Article  PubMed  Google Scholar 

  9. Katz MH, Pisters PW, Evans DB, et al. Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg. 2008;206:833–846.

    Article  PubMed  Google Scholar 

  10. Boulay BR, Gardner TB, Gordon SR. Occlusion rate and complications of plastic biliary stent placement in patients undergoing neoadjuvant chemoradiotherapy for pancreatic cancer with malignant biliary obstruction. J Clin Gastroenterol. 2010;44:389–390.

    Article  Google Scholar 

  11. Arguedas MR, Heudebert GH, Stinnett AA, Wilcox CM. Biliary stents in malignant obstructive jaundice due to pancreatic carcinoma: a cost-effectiveness analysis. Am J Gastroenterol. 2002;97:898–904.

    Article  PubMed  Google Scholar 

  12. Wasan SM, Ross WA, Staerkel GA, Lee JH. Use of expandable metallic biliary stents in resectable pancreatic cancer. Am J Gastroenterol. 2005;100:2056–2061.

    Article  PubMed  Google Scholar 

  13. Mullen JT, Lee JH, Gomez HF, et al. Pancreaticoduodenectomy after placement of endobiliary metal stents. J Gastrointest Surg. 2005;9:1094–1104.

    Article  PubMed  Google Scholar 

  14. Sanders MK, Slivka A, Moser JJ, et al. Placement of self-expanding metal stents (SEMS) in patients with resectable pancreatic cancer. Gastrointest Endosc. 2009;69:AB 266.

    Google Scholar 

  15. Lawrence C, Howell DA, Conklin DE, Stefan AM, Martin RF. Delayed pancreaticoduodenectomy for cancer patients with prior ERCP-placed, nonforeshortening, self-expanding metal stents: a positive outcome. Gastrointest Endosc. 2006;63:804–807.

    Article  PubMed  Google Scholar 

  16. Chen VK, Arguedas MR, Baron TH. Expandable metal biliary stents before pancreaticoduodenectomy for pancreatic cancer: a Monte-Carlo decision analysis. Clin Gastroenterol Hepatol. 2005;3:1229–1237.

    Article  PubMed  Google Scholar 

  17. Evans DB, Varadhachary GR, Crane CH, et al. Preoperative gemcitabine-based chemo radiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3496–3502.

    Article  PubMed  CAS  Google Scholar 

  18. Evans DB, For the multidisciplinary pancreatic cancer study G. Resectable pancreatic cancer: the role for neoadjuvant/preoperative therapy. HPB (Oxford). 2006;8:365–368.

    Article  Google Scholar 

  19. Varadhachary GR, Wolff RA, Crane CH, et al. Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemo radiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26:3487–3495.

    Article  PubMed  CAS  Google Scholar 

  20. Evans DB, Rich TA, Byrd DR, et al. Preoperative chemo radiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas. Arch Surg. 1992;127:1335–1339.

    Article  PubMed  CAS  Google Scholar 

  21. van der Gaag NA, Rauws EA, van Eijck CH, et al. Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010;362:129–137.

    Article  PubMed  Google Scholar 

  22. Rogart JN, Boghos A, Rossi F, et al. Analysis of endoscopic management of occluded metal biliary stents at a single tertiary care center. Gastrointest Endosc. 2008;68:676–682.

    Article  PubMed  Google Scholar 

  23. Ayaru L, Kurzawinski TR, Shankar A, Webster GJ, Hatfield AR, Pereira SP. Complications and diagnostic difficulties arising from biliary self-expanding metal stent insertion before definitive histological diagnosis. J Gastroenterol Hepatol. 2008;23:315–320.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jeffrey H. Lee.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singal, A.K., Ross, W.A., Guturu, P. et al. Self-Expanding Metal Stents for Biliary Drainage in Patients with Resectable Pancreatic Cancer: Single-Center Experience with 79 Cases. Dig Dis Sci 56, 3678–3684 (2011). https://doi.org/10.1007/s10620-011-1815-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-011-1815-7

Keywords

Navigation