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Self-expandable metal stents did not increase pancreaticoduodenectomy complications
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Patients with pancreatic cancer and self-expandable metal stents placed for biliary drainage did not experience more complications after pancreaticoduodenectomy than those with plastic or no stents in a recent study.
In a retrospective analysis, researchers evaluated 593 patients who underwent pancreaticoduodenectomy (PD) between March 2008 and July 2011 with self-expandable metal stents (SEMS), plastic endoscopic stents (PES) or no stents. Outcomes and incidence of perioperative complications were observed and compared among groups.
PD was successful in 509 cases, including 71 with SEMS, 149 with PES and 289 without stents at operation. SEMS was associated with longer operating time (median 279 minutes vs. 253 minutes with PES and 241 minutes with no stents; P<.001 for difference)and an increased incidence of wound infections (31% vs. 12.8% with PES and 6.2% with no stents (P<.001). No associations were observed between SEMS and incidence of overall or serious complications following the procedure, mortality at 30 days, length of hospital stay, positive margin or incidences of biliary anastomotic leak.
Among patients with adenocarcinomas, intraoperative determination of local unresectability occurred at similar rates between groups (19.3% of SEMS cases vs. 17.7% of PES; P=.862, and 17.5% of those with no stents; P=.732).
Patients without stents were found to be at significantly reduced risk for any complication compared with SEMS recipients (OR=0.519; 95% CI, 0.285-0.944), but not serious complications (OR=1.608; 95% CI, 0.761-3.398).
“Metal stents placed in the common bile duct do not interfere with surgery and can be used for all patients with pancreatic cancer and bile duct obstruction,” researcher Mark A. Schattner, MD, co-director of the hepatobiliary pancreas disease management team at Memorial Sloan-Kettering Cancer Center, told Healio.com. “Many endoscopists and surgeons have been placing plastic stents for patients who are going to the operating room. These stents are not as durable as metal stents. As more patients delay surgery to get neoadjuvant chemotherapy, they will need durable stents to provide adequate biliary drainage until surgery. Metal stents will provide this, and do not increase perioperative complications.”
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