title: Covered self-expandable metal stent deployment promises safe neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic head cancer.
abstract: BACKGROUND
  Patients with borderline resectable pancreatic head cancer (BRPHC) have been treated with neoadjuvant chemoradiation therapy (NACRT) using metallic stents. The aim of the present study was to evaluate the efficacy and complications of covered self-expanding metallic stents (CSEMS) during the NACRT and surgical period.
  
  
  METHODS
  We reviewed the outcomes of patients with BRPHC, then divided them chronologically into three groups as follows. Group A: upfront surgery with plastic stent (PS) deployment; group B: PS deployment plus neoadjuvant chemotherapy (NAC) and/or NACRT; group C: CSEMS deployment plus NAC/NACRT. Patients were categorized as borderline resectable based on National Comprehensive Cancer Network Guidelines, 2010. Days to reintervention (DR), reintervention rate, and the rate of R0 and complications were studied. Safe margin-negative resection (R0) surgery was defined as R0 surgery without reintervention during the NACRT period and no postoperative complications.
  
  
  RESULTS
  DR were as follows. Groups A, B and C were 32, 55 and 97 days, respectively (P < 0.05). R0 surgery obtained in groups A, B and C was 53% (9/17), 100% (17/17) and 93% (14/15), respectively. CSEMS did not interfere with surgery. Safe R0 surgery obtained in groups B and C was 11% (2/19) and 67% (10/15), respectively (P < 0.05). Multivariate analysis showed that the odds ratio for safe R0 surgery was 16.210 (95% CI 2.457-106.962, P = 0.003) for CSEMS placement.
  
  
  CONCLUSIONS
  CSEMS should be considered to relieve symptomatic biliary obstruction in patients with BRPHC receiving NACRT in view of the high attainability rate of safe R0 surgery compared to that with PS deployment.
authors.affiliation: Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Sato
authors.forename: Seitaro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hosono
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Mori
authors.forename: Koichi
authors.initials: K
authors.lastname: Taniguchi
authors.forename: Ryusei
authors.initials: R
authors.lastname: Matsuyama
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D059248:Chemoradiotherapy; D002985:Clinical Protocols; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008297:Male; D017538:Mesenteric Artery, Superior / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000601:surgery / Q000628:therapy*; D011300:Preoperative Care / Q000295:instrumentation; D011474:Prosthesis Design; D016717:Sphincterotomy, Endoscopic; D015607:Stents; D000093542:Gemcitabine
chemical_list: D000964:Antimetabolites, Antineoplastic; D003841:Deoxycytidine; D000093542:Gemcitabine
keywords: borderline resectable pancreatic head cancer (BRPHC); covered self-expanding metallic stent (CSEMS); neoadjuvant chemoradiation therapy (NACRT); plastic stent (PS)