Is metallic stenting worthwhile for biliary obstruction due to lymph node metastases?
BACKGROUND
The indications for metallic stents have widened from primary hepatobiliary cancers to the other diseases such as lymph node metastases from distant organs. The present study aimed to evaluate the results and establish the efficacy of metallic stenting in patients with obstructive jaundice due to metastatic lymph nodes.


METHODS
Stent patency, survival and cost per patient until death were retrospectively compared between patients with primary carcinoma of the biliary tract (PC group; n = 71) and lymph node metastases from the gastric and colorectal carcinomas. (LN group; n = 26).


RESULTS
Stent occlusion occurred in 17 patients in the PC group (24%). In contrast, stent occlusion was significantly more frequent in the LN group (P = 0.0293), occurring in 13 patients (50%). Cumulative stent patency was also significantly shorter in the LN group than that in the PC group (P = 0.0016). However, survival was almost the same between the two groups. The mean medical fee was 27% higher for the LN group than for the PC group, which was attributable to additional treatment for stent occlusion.


CONCLUSIONS
The indications for metallic stent placement for biliary obstruction caused by lymph node metastases from the gastrointestinal tract seem limited. Further investigation of the treatments alternative to metallic stents would be required.
Okamoto
Tomoyoshi
T
Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. tomoka@jikei.ac.jp
Yanagisawa
Satoru
S
Fujioka
Shuich
S
Gocho
Takeshi
T
Yanaga
Katsuhiko
K
Kakutani
Hiroshi
H
Tajiri
Hisao
H
D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000473:pathology; D003362:Cost-Benefit Analysis; D005260:Female; D005706:Gallbladder Neoplasms / Q000473:pathology; D005770:Gastrointestinal Neoplasms / Q000473:pathology; D006801:Humans; D041781:Jaundice, Obstructive / Q000191:economics / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D008670:Metals; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
D008670:Metals