Percutaneous palliation of pancreatic head cancer: randomized comparison of ePTFE/FEP-covered versus uncovered nitinol biliary stents.
The purpose of this study was to compare the clinical effectiveness of expanded polytetrafluoroethylene/fluorinated-ethylene-propylene (ePTFE/FEP)-covered stents with that of uncovered nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer. Eighty patients were enrolled in a prospective randomized study. Bare nitinol stents were used in half of the patients, and ePTFE/FEP-covered stents were used in the remaining patients. Patency, survival, complications, and mean cost were calculated in both groups. Mean patency was 166.0 ± 13.11 days for the bare-stent group and 234.0 ± 20.87 days for the covered-stent group (p = 0.007). Primary patency rates at 3, 6, and 12 months were 77.5, 69.8, and 69.8% for the bare-stent group and 97.5, 92.2, and 87.6% for the covered-stent group, respectively. Mean secondary patency was 123.7 ± 22.5 days for the bare-stent group and 130.3 ± 21.4 days for the covered-stent group. Tumour ingrowth occurred exclusively in the bare-stent group in 27.5% of cases (p = 0.002). Median survival was 203.2 ± 11.8 days for the bare-stent group and 247.0 ± 20 days for the covered-stent group (p = 0.06). Complications and mean cost were similar in both groups. Regarding primary patency and ingrowth rate, ePTFE/FEP-covered stents have shown to be significantly superior to bare nitinol stents for the palliation of malignant jaundice caused by inoperable pancreatic head cancer and pose comparable cost and complications. Use of a covered stent does not significantly influence overall survival rate; nevertheless, the covered endoprosthesis seems to offer result in fewer reinterventions and better quality of patient life.
Krokidis
Miltiadis
M
Department of Radiology, Guy's and St. Thomas' Hospitals, London, UK. mkrokidis@hotmail.com
Fanelli
Fabrizio
F
Orgera
Gianluigi
G
Tsetis
Dimitrios
D
Mouzas
Ioannis
I
Bezzi
Mario
M
Kouroumalis
Elias
E
Pasariello
Roberto
R
Hatzidakis
Adam
A
D000328:Adult; D000368:Aged; D000497:Alloys; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010179:Pancreas / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011138:Polytetrafluoroethylene / Q000031:analogs & derivatives; D011446:Prospective Studies; D011474:Prosthesis Design; D019919:Prosthesis Implantation; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D005465:Fluorocarbon Polymers
D000497:Alloys; D020099:Coated Materials, Biocompatible; D011138:Polytetrafluoroethylene; C096305:fluorinated ethylene propylene; D005465:Fluorocarbon Polymers; C013616:nitinol