Utility of Covered Self-Expanding Metal Stents for Biliary Drainage during Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Cancer
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Strategy of Biliary Drainage
2.3. Neoadjuvant Chemotherapy
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Complications Related to Biliary Stent Placement
3.3. Clinical Course during Neoadjuvant Chemotherapy
3.4. Outcomes of Surgery and Postoperative Complications
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristics | CSEMS Group (n = 21) | PS Group (n = 19) | p Value |
---|---|---|---|
Median age (years) | 63 (44–82) | 61 (41–90) | 0.456 |
Sex (male to female ratio) | 12:9 | 8:11 | 0.527 |
Tumor size (mm) | 30 (20–50) | 30 (18–40) | 0.345 |
Tumor location (head/body/tail) | 20/1/0 | 19/0/0 | 1.000 |
Classification (BRPC-A/BRPC-PV) | 13/8 | 12/7 | 0.935 |
Serological findings before drainage | |||
T-Bil (mg/dL) | 2.7 (0.3–23.3) | 5.3 (0.5–26.4) | 0.704 |
AST (IU/L) | 128 (13–818) | 160 (18–321) | 0.650 |
ALT (IU/L) | 232 (12–1212) | 296 (14–560) | 0.884 |
ALP (IU/L) | 1251 (84–3577) | 609 (117–3857) | 0.180 |
ENBD before stenting | 21 (100) | 9 (47.4) | <0.001 |
Neoadjuvant chemotherapy regimen | 0.554 | ||
Gemcitabine plus S-1 | 8 (38.1) | 9 (47.4) | |
Gemcitabine, nab-paclitaxel plus S-1 | 13 (61.9) | 10 (52.6) |
CSEMS Group (n = 21) | PS Group (n = 19) | p Value | |
---|---|---|---|
Recurrent biliary obstruction | 0 | 9 (47.4) | <0.001 |
Stent migration | 0 | 3 (15.8) | 0.098 |
Proximal side | 0 | 1 (5.3) | 0.475 |
Distal side | 0 | 2 (10.5) | 0.219 |
Stent occlusion | 0 | 6 (31.6) | 0.007 |
Sludge | 0 | 6 (31.6) | 0.007 |
Tumor ingrowth or overgrowth | 0 | 0 | - |
Biliary bleeding | 0 | 0 | - |
Food impaction | 0 | 0 | - |
Other complications | 4 (19.1) | 4 (21.1) | 1.000 |
Non-occlusive cholangitis | 3 (14.3) | 4 (21.1) | 0.689 |
Cholecystitis | 2 (9.5) | 0 | 0.489 |
Pancreatitis | 0 | 0 | - |
Gastrointestinal bleeding | 0 | 0 | - |
CSEMS Group (n = 21) | PS Group (n = 19) | p Value | |
---|---|---|---|
Time from the initiation of neoadjuvant chemotherapy to surgery (days) | 98 (70–110) | 99 (54–118) | 0.407 |
Gemcitabine + S-1 | 75.5 (70–107) | 87 (54–116) | 0.564 |
Gemcitabine + nab-paclitaxel + S-1 | 99 (92–110) | 99 (92–118) | 0.412 |
Delay in chemotherapy schedule, n (%) | 4/21 (19.1) | 12/19 (63.2) | 0.009 |
Gemcitabine + S-1 | 2/8 (25.0) | 8/9 (88.9) | 0.015 |
Gemcitabine + nab-paclitaxel + S-1 | 2/13 (15.4) | 4/10 (40.0) | 0.341 |
Delay in chemotherapy schedule due to stent-related complications, n (%) | 1/21 (4.8) | 10/19 (52.6) | 0.001 |
Gemcitabine + S-1 | 0/8 (0) | 6/9 (66.7) | 0.009 |
Gemcitabine + nab-paclitaxel + S-1 | 1/13 (7.7) | 4/10 (40.0) | 0.127 |
CSEMS Group (n = 21) | PS Group (n = 19) | p Value | |
---|---|---|---|
Pancreatectomy | 21 (100) | 17 (89.5) | 0.524 |
Surgical procedure | 0.354 | ||
PD | 18 (85.7) | 13 (76.5) | |
PD + hepatic artery resection | 2 (9.5) | 4 (23.5) | |
TP | 1 (4.8) | 0 | |
Arterial resection | 2 (9.5) | 5 (29.4) | 0.207 |
PV/SMV resection | 15 (71.4) | 11 (64.7) | 0.734 |
Operation time (min) | 358 (238–686) | 455 (238–676) | 0.081 |
Blood loss (mL) | 819 (45–6672) | 682 (158–2830) | 0.965 |
Postoperative complications | 6 (28.6) | 5 (26.3) | 0.955 |
Biliary fistula | 0 | 0 | - |
Pancreatic fistula | 0 | 2 (11.8) | 0.194 |
Cholangitis | 2 (9.5) | 1 (5.9) | 1.000 |
Gastrointestinal bleeding | 0 | 0 | - |
Delayed gastric emptying | 1 (4.8) | 2 (11.8) | 0.577 |
In-hospital mortality | 1 (4.8) | 0 | 1.000 |
Others | 3 (14.3) | 2 (11.8) | 1.000 |
Length of hospital stay (days) | 19 (15–285) | 19 (14–63) | 0.802 |
Study | Stents | Patients | Resectability | Neoadjuvant Therapy | RBO | Other Complications |
---|---|---|---|---|---|---|
Kubota [8], 2014 | PS | 21 | 21 BR | 11 NAC (G, GS) 10 NACRT (GS) | 86% | NR |
CSEMS | 17 | 17 BR | 17 NACRT (GS) | 24% | NR | |
Tsuboi [9], 2016 | PS | 11 | 11 BR | 11 NAC (GS) | 63.6% | 9.1% |
CSEMS | 9 | 9 BR | 9 NAC (GS) | 0% | 0% | |
Kuwatani [10], 2020 | PS | 12 | 6 R, 6 BR | 6 NAC (S-1), 6 NACRT (S-1) | 83% | 0% |
CSEMS | 17 | 8 R, 9 BR | 8 NAC (S-1) 9 NACRT (S-1) | 6% | 5.8% | |
Tamura [11], 2021 | PS | 11 | 11 BR | 11 NAC (GnP) | 64% | NR |
CSEMS | 11 | 11 BR | 11 NAC (GnP) | 18% | NR | |
Kobayashi [12], 2021 | PS | 22 | 15 R, 7 BR | 22 NACRT (S-1) | 95.4% | 0% |
CSEMS | 21 | 13 R, 8 BR | 21 NACRT (S-1) | 4.8% | 4.8% | |
Hasegawa [13], 2021 | PS | 40 | 1 R, 32 BR, 7 UR | 37 NACRT 3 NAC | 97% | 13% |
CSEMS | 27 | 3 R, 19 BR, 5 UR | 25 NACRT 2 NAC | 15% | 11% | |
Vehviläinen [14], 2022 | PS | 91 | NR | NAC/NACRT | 21% | NR |
CSEMS | 15 | NR | NAC/NACRT | 3% | NR |
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Furukawa, M.; Ishii, Y.; Serikawa, M.; Tsuboi, T.; Tatsukawa, Y.; Hirano, T.; Nakamura, S.; Ikemoto, J.; Kiyoshita, Y.; Saeki, S.; et al. Utility of Covered Self-Expanding Metal Stents for Biliary Drainage during Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Cancer. J. Clin. Med. 2023, 12, 6245. https://doi.org/10.3390/jcm12196245
Furukawa M, Ishii Y, Serikawa M, Tsuboi T, Tatsukawa Y, Hirano T, Nakamura S, Ikemoto J, Kiyoshita Y, Saeki S, et al. Utility of Covered Self-Expanding Metal Stents for Biliary Drainage during Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Cancer. Journal of Clinical Medicine. 2023; 12(19):6245. https://doi.org/10.3390/jcm12196245
Chicago/Turabian StyleFurukawa, Masaru, Yasutaka Ishii, Masahiro Serikawa, Tomofumi Tsuboi, Yumiko Tatsukawa, Tetsuro Hirano, Shinya Nakamura, Juri Ikemoto, Yusuke Kiyoshita, Sho Saeki, and et al. 2023. "Utility of Covered Self-Expanding Metal Stents for Biliary Drainage during Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Cancer" Journal of Clinical Medicine 12, no. 19: 6245. https://doi.org/10.3390/jcm12196245
APA StyleFurukawa, M., Ishii, Y., Serikawa, M., Tsuboi, T., Tatsukawa, Y., Hirano, T., Nakamura, S., Ikemoto, J., Kiyoshita, Y., Saeki, S., Tamura, Y., Miyamoto, S., Nakamura, K., Yamashita, Y., Iijima, N., Uemura, K., & Oka, S. (2023). Utility of Covered Self-Expanding Metal Stents for Biliary Drainage during Neoadjuvant Chemotherapy in Patients with Borderline Resectable Pancreatic Cancer. Journal of Clinical Medicine, 12(19), 6245. https://doi.org/10.3390/jcm12196245