title: Is metallic stenting worthwhile for biliary obstruction due to lymph node metastases?
abstract: 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.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan. tomoka@jikei.ac.jp
authors.forename: Tomoyoshi
authors.initials: T
authors.lastname: Okamoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Yanagisawa
authors.forename: Shuich
authors.initials: S
authors.lastname: Fujioka
authors.forename: Takeshi
authors.initials: T
authors.lastname: Gocho
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kakutani
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: 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
chemical_list: D008670:Metals