title: Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer.
abstract: In pancreatic cancer, preoperative biliary drainage (PBD) increases complications compared with surgery without PBD, demonstrated by a recent randomised controlled trial (RCT). This outcome might be related to the plastic endoprosthesis used. Metal stents may reduce the PBD-related complications risk.
  
  
  
  A prospective multicentre cohort study was performed including patients with obstructive jaundice due to pancreatic cancer, scheduled to undergo PBD before surgery. This cohort was added to the earlier RCT (ISRCTN31939699). The RCT protocol was adhered to, except PBD was performed with a fully covered self-expandable metal stent (FCSEMS). This FCSEMS cohort was compared with the RCT's plastic stent cohort. PBD-related complications were the primary outcome. Three-group comparison of overall complications including early surgery patients was performed.
  
  
  
  53 patients underwent PBD with FCSEMS compared with 102 patients treated with plastic stents. Patients' characteristics did not differ. PBD-related complication rates were 24% in the FCSEMS group vs 46% in the plastic stent group (relative risk of plastic stent use 1.9, 95% CI 1.1 to 3.2, p=0.011). Stent-related complications (occlusion and exchange) were 6% vs 31%. Surgical complications did not differ, 40% vs 47%. Overall complication rates for the FCSEMS, plastic stent and early surgery groups were 51% vs 74% vs 39%.
  
  
  
  For PBD in pancreatic cancer, FCSEMS yield a better outcome compared with plastic stents. Although early surgery without PBD remains the treatment of choice, FCSEMS should be preferred over plastic stents whenever PBD is indicated.
  
  
  
  Dutch Trial Registry (NTR3142).
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: J A M G
authors: JA
authors: Tol
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors: J E
authors: JE
authors: van Hooft
authors: Department of Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, The Netherlands.
authors: R
authors: R
authors: Timmer
authors: Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands.
authors: F J G M
authors: FJ
authors: Kubben
authors: Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
authors: E
authors: E
authors: van der Harst
authors: Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
authors: I H J T
authors: IH
authors: de Hingh
authors: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: F P
authors: FP
authors: Vleggaar
authors: Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: I Q
authors: IQ
authors: Molenaar
authors: Department of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors: Y C A
authors: YC
authors: Keulemans
authors: Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
authors: D
authors: D
authors: Boerma
authors: Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors: M J
authors: MJ
authors: Bruno
authors: Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands.
authors: E J
authors: EJ
authors: Schoon
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: N A
authors: NA
authors: van der Gaag
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: M G H
authors: MG
authors: Besselink
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors: P
authors: P
authors: Fockens
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: T M
authors: TM
authors: van Gulik
authors: Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
authors: E A J
authors: EA
authors: Rauws
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: O R C
authors: OR
authors: Busch
authors: Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
authors: D J
authors: DJ
authors: Gouma
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage / Q000379:methods; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008670:Metals; D009426:Netherlands; D010190:Pancreatic Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D016577:Pancreaticoduodenectomy; D010969:Plastics / Q000009:adverse effects; D011300:Preoperative Care; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D008670:Metals; D010969:Plastics
keywords: ABDOMINAL SURGERY; ADENOCARCINOMA; PANCREAS