title: Palliation With Endoscopic Metal Stents May Be Preferable to Surgical Intervention for Patients With Obstructive Pancreatic Head Adenocarcinoma.
abstract: The aim of this study was to evaluate the efficacy of endoscopically placed metal stents in comparison with operative procedures, in patients with obstructive pancreatic head cancer. Endoscopic stenting techniques and materials for gastrointestinal malignancies are constantly improving. Despite this evolution, many still consider operative procedures to be the gold standard for palliation in patients with unresectable obstructive pancreatic head cancer. This is a retrospective study of 52 patients who were diagnosed with obstructive (biliary, duodenal, or both) adenocarcinoma of the pancreatic head. Twenty-nine patients (endoscopy group) underwent endoscopic stenting. Eleven patients (bypass group) underwent biliodigestive bypass. Twelve patients (Whipple group) underwent Whipple operation with curative intent; however, histopathology revealed R1 resection (palliative Whipple). T4 disease was identified in 13 (44.8%), 7 (63.6%), and 3 (25%) patients in the endoscopy, bypass, and Whipple groups, respectively. Metastatic disease was present only in the endoscopy group (n = 12; 41.3%). There was no intervention-related mortality. Median survival was 280 days [95% confidence interval (95% CI), 103, 456 days], 157 days (95% CI, 0, 411 days), and 647 days (95% CI, 300, 993 days) for the endoscopy, bypass, and Whipple groups, respectively (P = 0.111). In patients with obstructive pancreatic head cancer, endoscopic stenting may offer equally good palliation compared with surgical double bypass. The numerically (not statistically) better survival after palliative Whipple might be explained by the smaller tumor burden in this subgroup of patients and not by the superior efficacy of this operation.
authors.affiliation: 1 Department of Interventional Gastroenterology.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Kofokotsios
authors.affiliation: 2 Department of Medical Oncology.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papazisis
authors.affiliation: 3 Department of Radiation Oncology, and.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Andronikidis
authors.affiliation: 4 Center for Hepato-Pancreato-Biliary Surgery, "Euromedica Geniki Kliniki" General Hospital, Thessaloniki, Greece.
authors.forename: Achilleas
authors.initials: A
authors.lastname: Ntinas
authors.affiliation: 4 Center for Hepato-Pancreato-Biliary Surgery, "Euromedica Geniki Kliniki" General Hospital, Thessaloniki, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kardassis
authors.affiliation: 4 Center for Hepato-Pancreato-Biliary Surgery, "Euromedica Geniki Kliniki" General Hospital, Thessaloniki, Greece.
authors.forename: Dionisios
authors.initials: D
authors.lastname: Vrochides
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Biliodigestive bypass; Endoscopy; Metal stents; Palliation; Pancreatic adenocarcinoma; Pancreaticoduodenectomy