title: Self-expanding metal stents for biliary drainage in patients with resectable pancreatic cancer: single-center experience with 79 cases.
abstract: OBJECTIVE
  To study pre-operative and peri-operative course and outcome on follow up after pancreaticoduodenenctomy (PD) for resectable pancreatic cancer amongst patients receiving self-expanding metal stents (SEMS).
  
  
  METHODS
  Medical charts of consecutively reviewed patients (2005-2009) with resectable pancreatic cancer and SEMS placement before PD at the MD Anderson Cancer Center (MDACC) were studied.
  
  
  RESULTS
  Seventy-nine patients (mean age, 68 ± 9 years; 54% males) undergoing PD after SEMS placement were analyzed. Of these, 70% (55/79) had come with previous plastic stents placed within a median of 29 (5-216) days because of presentation and most (95%) underwent neoadjuvant chemoradiation after SEMS placement. The median interval between SEMS placement and PD was 120 (range 28-306) days. There were no technical difficulties during PD. The resected tumor was stage T3 in 72 patients, positive node in 44, lymphovascular invasion in 47, and perineural invasion in 62. Within 30 days after surgery, 26 (33%) patients developed complications requiring intervention, but none died. During a median follow-up of 349 (14-1,508) days after surgery, 32 (41%) patients developed metastatic disease, and 20 (25%) died; median survival was approximately 3 years. Development of metastatic disease during follow-up independently predicted survival with hazard ratio of 16 (95% CI: 4-68; P = 0.0001).
  
  
  CONCLUSIONS
  Contrary to the tendency of avoiding the use of metal stents for biliary decompression amongst patients with resectable pancreatic cancer, our study demonstrated that SEMS did not adversely affect surgical technique, postoperative course, or long-term outcome. Therefore, metal stents should be considered for patients with resectable pancreatic cancer who will undergo preoperative chemoradiation.
authors.affiliation: Department of Gastroenterology Hepatology and Nutrition, Unit 1466, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
authors.forename: Ashwani K
authors.initials: AK
authors.lastname: Singal
authors.forename: William A
authors.initials: WA
authors.lastname: Ross
authors.forename: Praveen
authors.initials: P
authors.lastname: Guturu
authors.forename: Gauri R
authors.initials: GR
authors.lastname: Varadhachary
authors.forename: Milind
authors.initials: M
authors.lastname: Javle
authors.forename: Sathya R
authors.initials: SR
authors.lastname: Jaganmohan
authors.forename: Ramu P
authors.initials: RP
authors.lastname: Raju
authors.forename: Jason B
authors.initials: JB
authors.lastname: Fleming
authors.forename: Gottumukala S
authors.initials: GS
authors.lastname: Raju
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000368:Aged; D001646:Bile; D002779:Cholestasis / Q000209:etiology / Q000517:prevention & control*; D004322:Drainage / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011474:Prosthesis Design; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome