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

Tol, Johanna A. M. G.; Hooft, Jeanin E. van; Timmer, Robin; Kubben, F. J. G. M.; Harst, Erwin van der; Hingh, I.H.J.T. de; Vleggaar, Frank P.; Molenaar, I. Quintus; Keulemans, Yolande C.A.; Boerma, Djamila; Bruno, Marco J.; Schoon, Erik J.; Gaag, Niels A. van der; Besselink, Marc G.; Fockens, Paul; Gulik, Thomas M. van; Rauws, E. A. J.; Busch, Olivier R.; Gouma, Dirk J.

doi:10.1136/gutjnl-2014-308762

Cited by 160 publications

(153 citation statements)

References 34 publications

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“…It is controversial whether metal or plastic stents should be used for biliary obstruction caused by PC. In a recent study the use of metal stents was associated with an outcome benefit [28]. In our cohort metal stents were used more frequently than plastic ones.…”

Section: Discussionmentioning

confidence: 61%

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Lakatos

Balázs

Kui

et al. 2016

JGLD

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Background & Aims: Pancreatic cancer is a devastating disease with poor prognosis. There is very limited information available regarding the epidemiology and treatment strategies of pancreatic cancer in Central Europe. The purpose of the study was to prospectively collect and analyze data of pancreatic cancer in the Hungarian population. Methods: The Hungarian Pancreatic Study Group (HPSG) organized prospective, uniform data collection. Altogether 354 patients were enrolled from 14 Hungarian centers. Results: Chronic pancreatitis was present in 3.7% of the cases, while 33.7% of the patients had diabetes. Family history for pancreatic cancer was positive in 4.8%. The most frequent presenting symptoms included pain (63.8%), weight loss (63%) and jaundice (52.5%). The reported frequency of smoking and alcohol consumption was lower than expected (28.5% and 27.4%, respectively). The majority of patients (75.6%) were diagnosed with advanced disease. Most patients (83.6%) had a primary tumor located in the pancreatic head. The histological diagnosis was ductal adenocarcinoma in 90.7% of the cases, while neuroendocrine tumor was present in 5.3%. Biliary stent implantation was performed in 166 patients, 59.2% of them received metal stents. Primary tumor resection was performed in 60 (16.9%) patients. Enteral or biliary bypass was done in 35 and 49 patients, respectively. In a multivariate Cox-regression model, smoking status and presence of gemcitabine-based chemotherapy were identified as independent predictors for overall survival. Conclusion: We report the first data from a large cohort of Hungarian pancreatic cancer patients. We identified smoking status and chemotherapy as independent predictors in this cohort. Abbreviations: EBM: evidence-based medicine; EPI: exocrine pancreatic insufficiency; FNAB: fine needle aspiration biopsy; HPSG: Hungarian Pancreatic Study Group; MDCT: multi-detector computed tomography; OS: overall survival; PC: pancreatic cancer; RPP: Registry for Pancreatic Patients

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Section: Discussionmentioning

confidence: 61%

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Lakatos

Balázs

Kui

et al. 2016

JGLD

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“…Stent placement has been found to be associated with complications such as cholangitis and pancreatitis. Although early surgery without preoperative biliary drainage remains the treatment of choice, fully covered self-expandable metal stents may be preferred over plastic stents whenever preoperative biliary drainage is indicated [50]. In severely jaundiced patients with serum bilirubin levels ≥300 μmol/l, biliary stenting is a ppropriately recommended [51].…”

Section: Operability Assessmentmentioning

confidence: 99%

“…To be successful a screening program for pancreatic cancer needs to find and treat patients with T1N0M0 cancer with negative resection margins 50 years is a very interesting group that has so far not been subjected to screening [33]. However, the role of screening EUS/MRI even in high-risk individuals is still unclear.…”

Section: Risk Groups: How Do We Find Pancreatic Cancer Earlier?mentioning

confidence: 99%

Pancreatic Cancer: Yesterday, Today and Tomorrow

et al. 2016

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Pancreatic cancer is one of our most lethal malignancies. Despite substantial improvements in the survival rates for other major cancer forms, pancreatic cancer survival rates have remained relatively unchanged since the 1960s. Pancreatic cancer is usually detected at an advanced stage and most treatment regimens are ineffective, contributing to the poor overall prognosis. Herein, we review the current understanding of pancreatic cancer, focusing on central aspects of disease management from radiology, surgery and pathology to oncology. Historical remarks & present stateThe first known description of pancreatic cancer is attributed to Giovanni Battista Morgagni in his 1761 publication 'de Sedibus Et Causis Morborum Per Anatomen Indagatis Libri Quinque' [1]. However, the lack of a microscopic evaluation makes the true diagnosis of ductal adenocarcinoma uncertain. The next important advancement in our understanding of pancreatic cancer did not come until 1858, when Jacob Mendez Da Costa revisited Morgagni's original work and also described the first microscopic diagnosis of adenocarcinoma, manifesting pancreatic cancer as a true disease entity [2].The history of pancreatic surgery is fairly recent and involves a combination of brave surgical pioneers, the development of surgical anesthesia and modern aseptic techniques. Some landmarks in the history of pancreatic surgery deserve to be mentioned. The first reported attempt at a pancreaticoduodenectomy was performed in 1898 by the Italian surgeon Alessandro Codivilla for a tumor involving the head of the pancreas [3]; however, the patient did not survive the postoperative period. In the same year, William Stewart Halsted from Johns Hopkins Hospital performed the first successful resection for ampullary cancer by excising portions of the duodenum and the pancreas [4]. The first successful pancreaticoduodenectomy is credited to the German surgeon Walther Carl Eduard Kausch, as part of a two-stage procedure [5]. In 1914, Georg Hirschel performed the first successful pancreaticoduodenectomy in one stage [6] and then in 1935, Allen Oldfather Whipple presented the results of a two-stage procedure involving the resection of the head of the pancreas and duodenum for ampullary carcinoma at the annual meeting of the American Surgical Association, which renewed interest in pancreatic surgery [7]. During his career, Whipple performed 37 pancreaticoduodenectomies, with the procedure evolving into a one-stage technique [8,9], and 1964-1968 1969-1973 1974-1978 1979-1983 1984-1988 1989-1993 1994-1998 1999-2003 2004-2008 2009-2013 Period of diagnosis Whipple is generally credited with popularizing the operation that still bears his name. In 1937, Alexander Brunschwig performed the first successful pancreaticoduodenectomy for pancreatic adenocarcinoma [10]. Today, with the concentration of experience in high-volume hospitals, pancreatic surgery has become a safe procedure associated with an operative mortality below 3% [11][12][13]. While major advances have been made ...

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“…The study by Adams et al [51] found that the complication rate of plastic stents was almost 7 times higher than that of metal stents, and the rate of hospitalization for stent-related complications was 3-fold higher in the plastic stent group than in the metal stent group. Moreover, the study by Tol et al [52] showed that for resectable PC, both preoperative biliary drainage-related and stent-related complication rates were smaller in the metal stent group than in the plastic stent group (24 vs. 46, and 6 vs. 31%, respectively). The above data suggest that metal stents yield a better outcome compared with plastic stents.…”

Section: Endoscopic Biliary Stenting For Obstructive Jaundicementioning

confidence: 99%

Interventional Therapy for Pancreatic Cancer

Zhu

Jin

2016

Gastrointest Tumors

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Background: Palliative therapy and primarily chemoradiotherapy are the mainstream treatments in patients with locally advanced or metastatic pancreatic cancer (PC). Conventional endoscopy and endoscopic ultrasound (EUS)-guided interventional therapy has emerged as an important procedure for PC management. In this review, the progress in conventional endoscopy and EUS for PC management is discussed. Summary: For local palliative therapy against PC, EUS-guided fine needle injection (FNI) could deliver different kinds of agents, such as radioactive seeds and fiducials. Although their feasibility and safety have been proven, the long-term efficiency of EUS-FNI is still not established. For pain, EUS-celiac plexus neurolysis (CPN) is effective. However, CPN can only relieve the pain to a limited degree, with short duration. Endoscopy-guided stent placement is the preferred strategy for biliary and duodenal obstruction. Plastic and metal stents are equally effective for the relief of obstructive jaundice. The functional times of metal stents are longer than those of a plastic stent. Key Message: For biliary obstruction, a metal stent is the first choice. The long-term efficiency of EUS-FNI still needs further study. Practical Implications: Endoscopy and EUS-guided interventions have gradually become the mainstream method for local treatment of PC due to mini-invasiveness and real-time observation. PC is the second most common gastrointestinal malignancy and the sixth leading cause of cancer mortality in the United States, leading to about 4.0% of all cancer deaths [Siegel et al: CA Cancer J Clin 2014;64:9-29]. The only curative approach for patients with PC is surgical resection, but unfortunately 80-90% of patients have a surgically inoperable disease, with 53% having local metastases at the time of diagnosis [Weinberg et al: Oncology (Williston Park) 2015;29:809-820, 886]. Therefore, palliative therapy and primarily chemoradiotherapy are the mainstream of treatment in patients with locally advanced or metastatic PC. Although overall survival has improved from 6 to 8.5-11 months (some of them even survived for a year or more), the overall survival rate has not improved, and the 5-year survival is less than 4% [Weinberg et al: Oncology (Williston Park) 2015;29:809-820, 886; Greenlee et al: CA Cancer J Clin 2001;51:15-36; Zhang et al: Gastroenterol Res Pract 2016;2016:8962321]. Hence, it is crucial to develop more effective local treatment strategies for tumor tissue and symptom palliation. At present, endoscopy has gradually become the mainstream method for local treatment of gastrointestinal cancer due to mini-invasiveness and real-time observation. Conventional endoscopy can be used to manage the complication caused by PC, including endoscopic biliary stent placement for obstructive jaundice, and duodenal stent placement for duodenal obstruction. In addition, in those cases in whom obstructive jaundice failed to be relieved by endoscopic biliary stent placement, EUS-guided biliary drainage has emerged as an alternati...

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

Abstract: Dutch Trial Registry (NTR3142).

Cited by 160 publications

References 34 publications

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Pancreatic Cancer: Multicenter Prospective Data Collection and Analysis by the Hungarian Pancreatic Study Group

Pancreatic Cancer: Yesterday, Today and Tomorrow

Interventional Therapy for Pancreatic Cancer

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