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

Area of Science:

• Gastroenterology
• Surgical Oncology
• Medical Devices

Background:

• Preoperative biliary drainage (PBD) in pancreatic cancer patients is associated with increased complications, potentially due to plastic stents.
• Metal stents may offer a safer alternative for PBD.

Purpose of the Study:

• To compare the safety and efficacy of fully covered self-expandable metal stents (FCSEMS) versus plastic stents for PBD in pancreatic cancer.
• To evaluate PBD-related complications and overall complication rates.

Main Methods:

• A prospective multicentre cohort study added FCSEMS PBD patients to an existing randomized controlled trial (RCT) comparing plastic stents.
• The study compared PBD-related complications between FCSEMS (n=53) and plastic stent (n=102) groups.
• Overall complications were compared across FCSEMS, plastic stent, and early surgery groups.

Main Results:

• FCSEMS group had significantly lower PBD-related complication rates (24%) compared to the plastic stent group (46%).
• Stent-related complications were substantially lower with FCSEMS (6%) versus plastic stents (31%).
• Overall complication rates were 51% for FCSEMS, 74% for plastic stents, and 39% for early surgery.

Conclusions:

• Fully covered self-expandable metal stents (FCSEMS) demonstrate superior outcomes compared to plastic stents for PBD in pancreatic cancer.
• While early surgery without PBD is ideal, FCSEMS should be the preferred choice over plastic stents when PBD is indicated.