Self-expanding metal stents (SEMS) provide superior outcomes compared to plastic stents for pancreatic cancer patients undergoing neoadjuvant therapy
Abstract
Background: Neoadjuvant therapy is increasingly utilized for pancreatic cancer patients to decrease tumor
burden in anticipation of later surgical resection. However, infectious complications such as life threatening
cholangitis may occur for those with biliary obstruction. We hypothesized that placement of metal rather
than plastic stents in such patients results in lower rates of stent-related complications, leading to improved
clinical outcomes.
Methods: Retrospective cohort of pancreatic cancer patients treated by the University of Michigan
Multidisciplinary Pancreatic Cancer Destination Program between January 2005 and June 2010. Only
patients undergoing neoadjuvant therapy with one or more biliary stents placed for malignant obstruction
were studied. Time to stent complication was compared between metal and plastic stents. The complication
rate was estimated as the ratio of complications to total stent exposure time and 95% confidence intervals
were calculated.
Results: 52 patients met inclusion criteria. A total of 113 stents were placed in 52 patients (70 plastic,
43 metal). The complication rate was almost 7 times higher with plastic stents, 0.20 (95% CI, 0.14-0.30),
than with metal stents, 0.03 (95% CI, 0.01-0.06). Moreover, the rate of hospitalization for stent-related
complications was 3-fold higher in the plastic stent group than the metal stent group. The first quartile
estimate of time to stent complication was almost 5 times longer for metal than for plastic stents (44 vs. 200
days) (P<0.0001).
Conclusion: Compelling evidence indicates that self-expanding metal, not plastic stents should be used for
malignant biliary obstruction in patients undergoing neoadjuvant therapy for pancreatic cancer.
burden in anticipation of later surgical resection. However, infectious complications such as life threatening
cholangitis may occur for those with biliary obstruction. We hypothesized that placement of metal rather
than plastic stents in such patients results in lower rates of stent-related complications, leading to improved
clinical outcomes.
Methods: Retrospective cohort of pancreatic cancer patients treated by the University of Michigan
Multidisciplinary Pancreatic Cancer Destination Program between January 2005 and June 2010. Only
patients undergoing neoadjuvant therapy with one or more biliary stents placed for malignant obstruction
were studied. Time to stent complication was compared between metal and plastic stents. The complication
rate was estimated as the ratio of complications to total stent exposure time and 95% confidence intervals
were calculated.
Results: 52 patients met inclusion criteria. A total of 113 stents were placed in 52 patients (70 plastic,
43 metal). The complication rate was almost 7 times higher with plastic stents, 0.20 (95% CI, 0.14-0.30),
than with metal stents, 0.03 (95% CI, 0.01-0.06). Moreover, the rate of hospitalization for stent-related
complications was 3-fold higher in the plastic stent group than the metal stent group. The first quartile
estimate of time to stent complication was almost 5 times longer for metal than for plastic stents (44 vs. 200
days) (P<0.0001).
Conclusion: Compelling evidence indicates that self-expanding metal, not plastic stents should be used for
malignant biliary obstruction in patients undergoing neoadjuvant therapy for pancreatic cancer.