Division of Gastroenterology, Department of Internal Medicine, University of Michigan Health System;
J Gastrointest Oncol. 2012 Dec;3(4):309-13. doi: 10.3978/j.issn.2078-6891.2011.050.
Neoadjuvant therapy is increasingly utilized for pancreatic cancer patients to decrease tumor burden in anticipation of later surgical resection. However, infectious complications such as life threatening cholangitis may occur for those with biliary obstruction. We hypothesized that placement of metal rather than plastic stents in such patients results in lower rates of stent-related complications, leading to improved clinical outcomes.
Retrospective cohort of pancreatic cancer patients treated by the University of Michigan Multidisciplinary Pancreatic Cancer Destination Program between January 2005 and June 2010. Only patients undergoing neoadjuvant therapy with one or more biliary stents placed for malignant obstruction were studied. Time to stent complication was compared between metal and plastic stents. The complication rate was estimated as the ratio of complications to total stent exposure time and 95% confidence intervals were calculated.
52 patients met inclusion criteria. A total of 113 stents were placed in 52 patients (70 plastic, 43 metal). The complication rate was almost 7 times higher with plastic stents, 0.20 (95% CI, 0.14-0.30), than with metal stents, 0.03 (95% CI, 0.01-0.06). Moreover, the rate of hospitalization for stent-related complications was 3-fold higher in the plastic stent group than the metal stent group. The first quartile estimate of time to stent complication was almost 5 times longer for metal than for plastic stents (44 vs. 200 days) (P<0.0001).
Compelling evidence indicates that self-expanding metal, not plastic stents should be used for malignant biliary obstruction in patients undergoing neoadjuvant therapy for pancreatic cancer.
新辅助治疗越来越多地用于胰腺癌患者，以减少肿瘤负担，为以后的手术切除做准备。然而，对于有胆道梗阻的患者，可能会发生危及生命的胆管炎等感染性并发症。我们假设，在这些患者中放置金属支架而非塑料支架会降低支架相关并发症的发生率，从而改善临床结局。
这是一项对密歇根大学多学科胰腺癌治疗项目于 2005 年 1 月至 2010 年 6 月间治疗的胰腺癌患者进行的回顾性队列研究。仅研究了接受新辅助治疗且因恶性梗阻放置一个或多个胆道支架的患者。比较金属和塑料支架之间发生支架并发症的时间。将并发症发生率定义为并发症与总支架暴露时间的比值，并计算 95%置信区间。
52 名患者符合纳入标准。52 名患者共放置 113 个支架（70 个塑料支架，43 个金属支架）。塑料支架的并发症发生率（0.20，95%CI，0.14-0.30）几乎是金属支架（0.03，95%CI，0.01-0.06）的 7 倍。此外，塑料支架组因支架相关并发症住院的比例是金属支架组的 3 倍。金属支架组首次发生支架并发症的时间估计中位数几乎是塑料支架组的 5 倍（44 天 vs. 200 天）（P<0.0001）。
强有力的证据表明，在接受新辅助治疗的胰腺癌患者中，对于恶性胆道梗阻，应使用自膨式金属支架，而非塑料支架。
