Stent patency in patients with distal malignant biliary obstruction receiving chemo(radio)therapy

 

 Permissions and Reprints

Abstract

Background and study aims Recent literature suggests that chemo(radio)therapy might reduce the patency of plastic stents in patients with malignant biliary obstruction. Whether this might also be valid for other types of stents is unknown. The aim of this study was to determine the influence of chemo(radio)therapy on the patency of fully-covered self-expandable metal stents (FCSEMSs) and plastic stents.

Patients and methods We retrospectively reviewed the electronic medical records of patients with distal malignant biliary obstruction who underwent biliary stent placement between April 2001 and July 2015. Primary outcome was duration of stent patency. Secondary outcome was stent patency at 3 and 6 months. We used Kaplan–Meier survival analyses to compare stent patency rates between patients who received chemo(radio)therapy and patients who did not.

Results A total of 291 biliary stents (151 metal and 140 plastic) were identified. The median cumulative stent patency of FCSEMSs did not differ between patients receiving chemo(radio)therapy (n = 51) and those (n = 100) who did not (P = 0.70, log-rank test). The estimated cumulative stent patency of plastic stents was also comparable in 99 patients without and 41 patients with chemo(radio)therapy (P = 0.73, log-rank test). At 3 and 6 months, FCSEMS patency rates were 87 % and 83 % in patients without chemo(radio)therapy and 96 % and 83 % in patients with therapy, respectively. Plastic patency rates were 69 % and 55 % in patients without and 85 % and 39 % in patients with therapy, respectively. After 1 year, 78 % of the FCSEMSs were still patent in patients without chemo(radio)therapy and 69 % of the FCSEMSs were still patent in patients with therapy.

Conclusion Our data indicate that chemo(radio)therapy does not reduce the patency of biliary fully-covered metal and plastic stents.

• References

• 1 Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J. et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer 2013; 49: 1374-1403
  CrossrefPubMedGoogle Scholar
• 2 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5-29
  CrossrefPubMedGoogle Scholar
• 3 SEER Cancer Statistics Factsheets: Pancreas Cancer. Bethesda, Maryland: National Cancer Institute; 2015 Available from: http://seer.cancer.gov/statfacts/html/pancreas.html Accessed: 25 October 2015
  PubMedGoogle Scholar
• 4 Sperti C, Pasquali C, Piccoli A. et al. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg 1997; 21: 195-200
  CrossrefPubMedGoogle Scholar
• 5 Oettle H, Post S, Neuhaus P. et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer. JAMA 2007; 297: 267-277
  CrossrefPubMedGoogle Scholar
• 6 Gillen S, Schuster T, Meyer ZumBüschenfelde C. et al. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 2010; 7: e1000267
  CrossrefPubMedGoogle Scholar
• 7 Artinyan A, Anaya DA, McKenzie S. et al. Neoadjuvant therapy is associated with improved survival in resectable pancreatic adenocarcinoma. Cancer 2011; 117: 2044-2049
  CrossrefPubMedGoogle Scholar
• 8 Lillemoe KD, Pitt HA. Palliation. Surgical and otherwise. Cancer 1996; 78: 605-614
  CrossrefPubMedGoogle Scholar
• 9 Eklund JW, Trifilio S, Mulcahy MF. Chemotherapy dosing in the setting of liver dysfunction. Oncology (Williston Park) 2005; 19: 1057-1063 ; discussion 1063-1064, 1069
  PubMedGoogle Scholar
• 10 Speer AG, Cotton PB, Russel RC. et al. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet 1987; 2: 57-62
  CrossrefPubMedGoogle Scholar
• 11 Smith AC, Dowsett JF, Russell RC. et al. Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet 1994; 344: 1655-1660
  CrossrefPubMedGoogle Scholar
• 12 Almadi MA, Barkun A, Martel M. Plastic vs. self-expandable metal stents for palliation in malignant biliary obstruction: a series of meta-analyses. Am J Gastroenterol 2017; 112: 260-273
  CrossrefPubMedGoogle Scholar
• 13 Ge PS, Hamerski CM, Watson RR. et al. Plastic biliary stent patency in patients with locally advanced pancreatic adenocarcinoma receiving downstaging chemotherapy. Gastrointest Endosc 2015; 81: 360-366
  CrossrefPubMedGoogle Scholar
• 14 Adams MA, Anderson MA, Myles JD. et al. Self-expanding metal stents (SEMS) provide superior outcomes compared to plastic stents for pancreatic cancer patients undergoing neoadjuvant therapy. J Gastrointest Oncol 2012; 3: 309-313
  PubMedGoogle Scholar
• 15 Aadam AA, Evans DB, Khan A. et al. Efficacy and safety of self-expandable metal stents for biliary decompression in patients receiving neoadjuvant therapy for pancreatic cancer: a prospective study. Gastrointest Endosc 2012; 76: 67-75
  CrossrefPubMedGoogle Scholar
• 16 Lofts FJ, Evans TR, Mansi JL. et al. Bile duct stents: is there an increased rate of complications in patients receiving chemotherapy?. Eur J Cancer 1997; 33: 209-213
  CrossrefPubMedGoogle Scholar
• 17 Dumonceau JM, Tringali A, Blero D. et al. Biliary stenting: Indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline. Endoscopy 2012; 44: 277-298
  Article in Thieme ConnectPubMedGoogle Scholar
• 18 Boulay BR, Parepally M. Managing malignant biliary obstruction in pancreas cancer: Choosing the appropriate strategy. World J Gastroenterol 2014; 20: 9345-9353
  PubMedGoogle Scholar
• 19 Walter D, van Boeckel PG, Groenen MJ. et al. Cost efficacy of metal stents for palliation of extrahepatic bile duct obstruction in a randomized controlled trial. Gastroenterology 2015; 149: 130-138
  CrossrefPubMedGoogle Scholar
• 20 Boulay BR, Gardner TB, Gordon SR. Occlusion rate and complications of plastic biliary stent placement in patients undergoing neoadjuvant chemoradiotherapy for pancreatic cancer with malignant biliary obstruction. J Clin Gastroenterol 2010; 44: 452-455
  PubMedGoogle Scholar
• 21 Wasan SM, Ross WA, Staerkel GA. et al. Use of expandable metallic biliary stents in resectable pancreatic cancer. Am J Gastroenterol 2005; 100: 2056-2061
  CrossrefPubMedGoogle Scholar
• 22 Siddiqui AA, Mehendiratta V, Loren D. et al. Self-expanding metal stents (SEMS) for preoperative biliary decompression in patients with resectable and borderline-resectable pancreatic cancer: outcomes in 241 patients. Dig Dis Sci 2013; 58: 1744-1750
  CrossrefPubMedGoogle Scholar
• 23 Kubota K, Sato T, Watanabe S. et al. Covered self-expandable metal stent deployment promises safe neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic head cancer. Dig Endosc 2014; 26: 77-86
  CrossrefPubMedGoogle Scholar
• 24 Gardner TB, Spangler CC, Byanova KL. et al. Cost-effectiveness and clinical efficacy of biliary stents in patients undergoing neoadjuvant therapy for pancreatic adenocarcinoma in a randomized controlled trial. Gastrointest Endosc 2016; 84: 460-466
  CrossrefPubMedGoogle Scholar
• 25 Nakai Y, Isayama H, Kawabe T. et al. Efficacy and safety of metallic stents in patients with unresectable pancreatic cancer receiving gemcitabine. Pancreas 2008; 37: 405-410
  CrossrefPubMedGoogle Scholar
• 26 Kitano M, Yamashita Y, Tanaka K. et al. Covered self-expandable metal stents with an anti-migration system improve patency duration without increased complications compared with uncovered stents for distal biliary obstruction caused by pancreatic carcinoma: a randomized multicenter trial. Am J Gastroenterol 2013; 108: 1713-1722
  CrossrefPubMedGoogle Scholar
• 27 Kahaleh M, Brock A, Conaway MR. et al. Covered self-expandable metal stents in pancreatic malignancy regardless of resectability: a new concept validated by a decision analysis. Endoscopy 2007; 39: 319-324
  Article in Thieme ConnectPubMedGoogle Scholar
• 28 Takasawa O, Fujita N, Kobayashi G. et al. Endoscopic biliary drainage for patients with unresectable pancreatic cancer with obstructive jaundice who are to undergo gemcitabine chemotherapy. World J Gastroenterol 2006; 12: 7299-7303
  CrossrefPubMedGoogle Scholar