Gut and Liver https://doi.org/10.5009/gnl18573 Clinical Outcomes of Biliary Drainage during a Neoadjuvant Therapy for Pancreatic Cancer: Metal versus Plastic Stents
Author Information
Masaki Kuwatani1 , Toru Nakamura2 , Tsuyoshi Hayashi3 , Yasutoshi Kimura4 , Michihiro Ono5 , Masayo Motoya6 , Koji Imai7 , Keisuke Yamakita8 , Takuma Goto9 , Kuniyuki Takahashi3 , Hiroyuki Maguchi3 , Satoshi Hirano2 , and Hokkaido Pancreatic Cancer Study Group (HOPS)
1Department of Gastroenterology and Hepatology, Hokkaido University Hospital, 2Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, 3Center for Gastroenterology, Teine Keijinkai Hospital, 4Department of Surgery, Surgical Oncology and Science, and Departments of 5Medical Oncology and 6Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, 7Department of Surgery, and Divisions of 8Metabolism and Biosystemic Science and 9Gastroenterology and Hematology/Oncology, Asahikawa Medical University, Asahikawa, Japan

Masaki Kuwatani
Department of Gastroenterology and Hepatology, Hokkaido University Hospital, North 14, West 5, Kita-ku, Sapporo 060-8648, Japan
Tel: +81-11-716-1161 (ext. 5918), Fax: +81-11-706-7867, E-mail: mkuwatan@med.hokudai.ac.jp
© The Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer. All rights reserved.

Abstract
Neoadjuvant chemotherapy/neoadjuvant chemoradiotherapy (NAC/NACRT) can be performed in patients with pancreatic cancer to improve survival. We aimed to clarify the clinical outcomes of biliary drainage with a metal stent (MS) or a plastic stent (PS) during NAC/NACRT. Between October 2013 and April 2016, 96 patients with pancreatic cancer were registered for NAC/NACRT. Of these, 29 patients who underwent biliary drainage with MS or PS before NAC/NACRT and a subsequent pancreatoduodenectomy were retrospectively analyzed with regard to patient characteristics, preoperative recurrent biliary obstruction rate, NAC/NACRT delay or discontinuation rate, and operative characteristics. The median age of the patients was 67 years. NAC and NACRT were performed in 14 and 15 patients, respectively, and MS and PS were used in 17 and 12 patients, respectively. Recurrent biliary obstruction occurred in 6% and 83% of the patients in the MS and PS groups, respectively (p<0.001). NAC/NACRT delay was observed in 35% and 50% of the patients in the MS and PS groups, respectively (p=0.68). NAC/NACRT discontinuation was observed in 12% and 17% of the patients in the MS and PS groups, respectively (p=1). The operative time in the MS group tended to be longer than that in the PS group (625 minutes vs 497 minutes, p=0.0513), and the operative blood loss volumes and postoperative adverse event rates were not different between the two groups. MS was better than PS from the viewpoint of preventing recurrent biliary obstruction, although MS was similar to PS with regards to perioperative outcomes.
Keywords: Pancreatic neoplasms; Chemotherapy; Chemoradiotherapy; Jaundice; Stent
Abstract
Neoadjuvant chemotherapy/neoadjuvant chemoradiotherapy (NAC/NACRT) can be performed in patients with pancreatic cancer to improve survival. We aimed to clarify the clinical outcomes of biliary drainage with a metal stent (MS) or a plastic stent (PS) during NAC/NACRT. Between October 2013 and April 2016, 96 patients with pancreatic cancer were registered for NAC/NACRT. Of these, 29 patients who underwent biliary drainage with MS or PS before NAC/NACRT and a subsequent pancreatoduodenectomy were retrospectively analyzed with regard to patient characteristics, preoperative recurrent biliary obstruction rate, NAC/NACRT delay or discontinuation rate, and operative characteristics. The median age of the patients was 67 years. NAC and NACRT were performed in 14 and 15 patients, respectively, and MS and PS were used in 17 and 12 patients, respectively. Recurrent biliary obstruction occurred in 6% and 83% of the patients in the MS and PS groups, respectively (p<0.001). NAC/NACRT delay was observed in 35% and 50% of the patients in the MS and PS groups, respectively (p=0.68). NAC/NACRT discontinuation was observed in 12% and 17% of the patients in the MS and PS groups, respectively (p=1). The operative time in the MS group tended to be longer than that in the PS group (625 minutes vs 497 minutes, p=0.0513), and the operative blood loss volumes and postoperative adverse event rates were not different between the two groups. MS was better than PS from the viewpoint of preventing recurrent biliary obstruction, although MS was similar to PS with regards to perioperative outcomes.
Keywords: Pancreatic neoplasms; Chemotherapy; Chemoradiotherapy; Jaundice; Stent
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