A Comparison Between Plastic and Metallic Biliary Stent Placement in Patients Receiving Preoperative Neoadjuvant Chemoradiotherapy for Resectable Pancreatic Cancer.
Adult
Aged
Antineoplastic Agents
/ therapeutic use
Chemoradiotherapy, Adjuvant
Deoxycytidine
/ analogs & derivatives
Drainage
/ economics
Female
Health Care Costs
Humans
Male
Metals
Middle Aged
Neoadjuvant Therapy
Pancreatectomy
Pancreatic Neoplasms
/ therapy
Plastics
Retrospective Studies
Stents
/ adverse effects
Treatment Outcome
Gemcitabine
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
Feb 2019
Feb 2019
Historique:
pubmed:
10
10
2018
medline:
25
6
2019
entrez:
10
10
2018
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Identifiants
pubmed: 30298284
doi: 10.1007/s00268-018-4820-6
pii: 10.1007/s00268-018-4820-6
doi:
Substances chimiques
Antineoplastic Agents
0
Metals
0
Plastics
0
Deoxycytidine
0W860991D6
Gemcitabine
0
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
642-648Références
Lancet. 1992 Dec 19-26;340(8834-8835):1488-92
pubmed: 1281903
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Surgery. 2005 Jul;138(1):8-13
pubmed: 16003309
Am J Gastroenterol. 2005 Sep;100(9):2056-61
pubmed: 16128952
J Gastrointest Surg. 2005 Nov;9(8):1094-104; discussion 1104-5
pubmed: 16269380
Surg Endosc. 2006 Apr;20 Suppl 2:S446-9
pubmed: 16557419
Gastrointest Endosc. 2006 Jun;63(7):986-95
pubmed: 16733114
Surgery. 2007 Jul;142(1):20-5
pubmed: 17629996
J Gastrointest Surg. 2008 Apr;12(4):701-6
pubmed: 18027062
Ann Surg. 2008 Mar;247(3):456-62
pubmed: 18376190
N Engl J Med. 2010 Jan 14;362(2):129-37
pubmed: 20071702
J Clin Gastroenterol. 2010 Jul;44(6):452-5
pubmed: 20179612
Ann Surg Oncol. 2010 Jun;17(6):1471-4
pubmed: 20180029
Ann Surg Oncol. 2010 Nov;17(11):2832-8
pubmed: 20725860
J Gastrointest Surg. 2011 Nov;15(11):2059-69
pubmed: 21913045
Dig Endosc. 2011 Oct;23(4):310-5
pubmed: 21951091
Ann Surg Oncol. 2012 May;19(5):1644-62
pubmed: 22012027
J Gastrointest Surg. 2012 Jan;16(1):68-78; discussion 78-9
pubmed: 22065318
J Surg Oncol. 2012 Jul 1;106(1):111-8
pubmed: 22311829
Gastrointest Endosc. 2012 Jul;76(1):67-75
pubmed: 22483859
J Hepatobiliary Pancreat Sci. 2013 Feb;20(2):197-205
pubmed: 22766692
Dig Endosc. 2014 Jan;26(1):77-86
pubmed: 23551230
World J Gastroenterol. 2013 Dec 14;19(46):8638-46
pubmed: 24379581
Langenbecks Arch Surg. 2015 May;400(4):477-85
pubmed: 25929828
Gut. 2016 Dec;65(12):1981-1987
pubmed: 26306760
Gastrointest Endosc. 2016 Sep;84(3):460-6
pubmed: 26972022
Am J Gastroenterol. 2017 Feb;112(2):260-273
pubmed: 27845340
Radiology. 1996 Oct;201(1):167-72
pubmed: 8816539
Gastrointest Endosc. 1998 Jan;47(1):1-7
pubmed: 9468416
Gut. 1998 Jan;42(1):76-80
pubmed: 9505889