Du Jianbing, Gao Xiangyu, Zhang Hongtao, Wan Zhuo, Yu Hengchao, Wang Desheng
Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Front Surg. 2022 Jun 30;9:875504. doi: 10.3389/fsurg.2022.875504. eCollection 2022.
With the increasing use of neoadjuvant therapy (NAT) in patients with pancreatic cancer to reduce tumor burden on prognosis, preoperative biliary drainage (PBD) is becoming increasingly necessary. The aim of this study was to summarize the latest evidence and compare the clinical efficacy of metal stents (MS) and plastic stents (PS) in patients undergoing neoadjuvant therapy for operable pancreatic cancer. Eligible studies were searched in PubMed, Embase and Cochrane Library from their inception to September 2021. In this study, RevMan 5.4 was used to perform the analyses. Two randomized controlled trials (RCTs) and six retrospective studies with 316 patients were included. All patients had pancreatic cancer and received NAT before surgical resection. Meta-analysis showed that the rate of endoscopic reintervention in MS (26/143, 18%) group was lower than that of PS (122/153, 80%) group ( < 0.05). The rate of stent-related complications in MS group was lower (18/118, 15%) than that of PS (52/117, 44%) group ( = 0.02). But there were no significant differences in operative time, operative blood loss, overall postoperative complications, postoperative hospitalization days and total medical costs between the two groups. For operable pancreatic cancer patients undergoing NAT surgery, MS was preferred over PS in terms of the incidence of endoscopic reintervention and stent-related complications. More clinical trials are needed in the future to confirm these data with higher levels of evidence.
随着新辅助治疗（NAT）在胰腺癌患者中越来越多地用于减轻肿瘤负荷对预后的影响，术前胆道引流（PBD）变得越来越必要。本研究的目的是总结最新证据，并比较金属支架（MS）和塑料支架（PS）在可切除胰腺癌新辅助治疗患者中的临床疗效。从创刊至2021年9月，在PubMed、Embase和Cochrane图书馆中检索符合条件的研究。在本研究中，使用RevMan 5.4进行分析。纳入两项随机对照试验（RCT）和六项回顾性研究，共316例患者。所有患者均患有胰腺癌，并在手术切除前接受了NAT。荟萃分析显示，MS组（26/143，18%）的内镜再干预率低于PS组（122/153，80%）（<0.05）。MS组的支架相关并发症发生率较低（18/118，15%），低于PS组（52/117，44%）（=0.02）。但两组在手术时间﹑术中出血量﹑术后总体并发症﹑术后住院天数和总医疗费用方面无显著差异。对于接受NAT手术的可切除胰腺癌患者，在内镜再干预发生率和支架相关并发症方面，MS优于PS。未来需要更多的临床试验以更高水平证据证实这些数据。
