Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer

J. A. M. G. Tol; J. E. van Hooft; R. Timmer; F. J. G. M. Kubben; E. van der Harst; I. H. J. T. de Hingh; F. P. Vleggaar; I. Q. Molenaar; Y. C. A. Keulemans; D. Boerma; M. J. Bruno; E. J. Schoon; N. A. van der Gaag; M. G. H. Besselink; P. Fockens; T. M. van Gulik; E. A. J. Rauws; O. R. C. Busch; D. J. Gouma

doi:https://doi.org/10.1136/gutjnl-2014-308762

Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer

J. A. M. G. Tol, J. E. van Hooft, R. Timmer, F. J. G. M. Kubben, E. van der Harst, I. H. J. T. de Hingh, F. P. Vleggaar, I. Q. Molenaar, Y. C. A. Keulemans, D. Boerma, M. J. Bruno, E. J. Schoon, N. A. van der Gaag, M. G. H. Besselink, P. Fockens, T. M. van Gulik, E. A. J. Rauws, O. R. C. Busch, D. J. Gouma

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Abstract

In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. Dutch Trial Registry (NTR3142)

Original language	English
Pages (from-to)	1981-1987
Journal	Gut
Volume	65
Issue number	12
Early online date	2016
DOIs	https://doi.org/10.1136/gutjnl-2014-308762
Publication status	Published - 2016

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https://doi.org/10.1136/gutjnl-2014-308762

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Tol, J. A. M. G., van Hooft, J. E., Timmer, R., Kubben, F. J. G. M., van der Harst, E., de Hingh, I. H. J. T., Vleggaar, F. P., Molenaar, I. Q., Keulemans, Y. C. A., Boerma, D., Bruno, M. J., Schoon, E. J., van der Gaag, N. A., Besselink, M. G. H., Fockens, P., van Gulik, T. M., Rauws, E. A. J., Busch, O. R. C., & Gouma, D. J. (2016). Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer. Gut, 65(12), 1981-1987. https://doi.org/10.1136/gutjnl-2014-308762

@article{c625c2b7b7914004857ca8283ab2154e,

title = "Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer",

abstract = "In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. Dutch Trial Registry (NTR3142)",

author = "Tol, {J. A. M. G.} and {van Hooft}, {J. E.} and R. Timmer and Kubben, {F. J. G. M.} and {van der Harst}, E. and {de Hingh}, {I. H. J. T.} and Vleggaar, {F. P.} and Molenaar, {I. Q.} and Keulemans, {Y. C. A.} and D. Boerma and Bruno, {M. J.} and Schoon, {E. J.} and {van der Gaag}, {N. A.} and Besselink, {M. G. H.} and P. Fockens and {van Gulik}, {T. M.} and Rauws, {E. A. J.} and Busch, {O. R. C.} and Gouma, {D. J.}",

year = "2016",

doi = "https://doi.org/10.1136/gutjnl-2014-308762",

language = "English",

volume = "65",

pages = "1981--1987",

journal = "Gut",

issn = "0017-5749",

publisher = "BMJ Publishing Group",

number = "12",

}

Tol, JAMG, van Hooft, JE, Timmer, R, Kubben, FJGM, van der Harst, E, de Hingh, IHJT, Vleggaar, FP, Molenaar, IQ, Keulemans, YCA, Boerma, D, Bruno, MJ, Schoon, EJ, van der Gaag, NA, Besselink, MGH , Fockens, P , van Gulik, TM, Rauws, EAJ, Busch, ORC & Gouma, DJ 2016, 'Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer', Gut, vol. 65, no. 12, pp. 1981-1987. https://doi.org/10.1136/gutjnl-2014-308762

TY - JOUR

T1 - Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer

AU - Tol, J. A. M. G.

AU - van Hooft, J. E.

AU - Timmer, R.

AU - Kubben, F. J. G. M.

AU - van der Harst, E.

AU - de Hingh, I. H. J. T.

AU - Vleggaar, F. P.

AU - Molenaar, I. Q.

AU - Keulemans, Y. C. A.

AU - Boerma, D.

AU - Bruno, M. J.

AU - Schoon, E. J.

AU - van der Gaag, N. A.

AU - Besselink, M. G. H.

AU - Fockens, P.

AU - van Gulik, T. M.

AU - Rauws, E. A. J.

AU - Busch, O. R. C.

AU - Gouma, D. J.

PY - 2016

Y1 - 2016

N2 - In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. Dutch Trial Registry (NTR3142)

AB - In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk. A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed. 53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%. For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated. Dutch Trial Registry (NTR3142)

U2 - https://doi.org/10.1136/gutjnl-2014-308762

DO - https://doi.org/10.1136/gutjnl-2014-308762

M3 - Article

C2 - 26306760

SN - 0017-5749

VL - 65

SP - 1981

EP - 1987

JO - Gut

JF - Gut

IS - 12

ER -