Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors.
BACKGROUND
Preoperative biliary drainage (PBD) with stenting increases complications compared with surgery without PBD. Metallic stents are considered superior to plastic stents when considering stent-related complications. Aim of the present systematic review and meta-analysis is to compare the rate of endoscopic re-intervention before surgery and postoperative outcomes of metal versus plastic stents in patients with resectable periampullary or pancreatic head neoplasms.


METHODS
We conducted a bibliographic research using the National Library of Medicine's PubMed database, including both randomized controlled trials (RCTs) and non-RCTs. Quantitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Statistical heterogeneity was assessed using the I(2) tests.


RESULTS
One RCT and four non-RCTs were selected, including 704 patients. Of these, 202 patients (29.5%) were treated with metal stents and 502 (70.5%) with plastic stents. The majority of patients (86.4%) had pancreatic cancer. The rate of endoscopic re-intervention after preoperative biliary drainage was significantly lower in the metal stent (3.4%) than in the plastic stent (14.8%) group (p < 0.0001). The rate of postoperative pancreatic fistula was significantly lower in the meta stent group as well (5.1% versus 11.8%, p = 0.04). The rate of post-operative surgical complications and of - post-operative mortality did not differ between the two groups.


CONCLUSIONS
Although the present systematic review and meta-analysis demonstrates that metal stent are more effective than plastic stents for PBD in patients with resectable periampullary tumors, randomized controlled trials are needed in order to confirm these data with a higher level of evidence.
Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
S
S
Crippa
Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, Terni, Italy.
R
R
Cirocchi
Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
S
S
Partelli
Division of Pancreato-Biliary Endoscopy and Endoscopic Ultrasound, San Raffaele Scientific Institute, Milan, Italy.
M C
MC
Petrone
Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy.
F
F
Muffatti
Department of General and Oncologic Surgery, University of Perugia, Perugia, Italy.
C
C
Renzi
Division of Pancreatic Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy. Electronic address: falconi.massimo@hsr.it.
M
M
Falconi
Division of Pancreato-Biliary Endoscopy and Endoscopic Ultrasound, San Raffaele Scientific Institute, Milan, Italy.
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PG
Arcidiacono
D014670:Ampulla of Vater; D001662:Biliary Tract Surgical Procedures / Q000295:instrumentation*; D004322:Drainage / Q000295:instrumentation; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008670:Metals; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D010969:Plastics; D011183:Postoperative Complications / Q000453:epidemiology*; D011300:Preoperative Care / Q000706:statistics & numerical data; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data*
D008670:Metals; D010969:Plastics
Jaundice; Metal stent; Pancreatic cancer; Periampullary tumors; Plastic stent; Resectable