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Comparison of outcomes between secondary fully covered and uncovered self-expandable metal stents in the treatment of recurrent biliary obstruction of pancreatic cancer

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Abstract

Background

The overall survival (OS) of pancreatic cancer (PC) has been prolonged by advances in chemotherapy, and the number of cases of recurrent biliary obstruction (RBO) after self-expandable metal stent (SEMS) placement is expected to increase. We herein compared outcomes between secondary fully covered SEMS (FC) and uncovered SEMS (UC) for RBO of PC with FC placed as the 1st SEMS.

Methods

Between May 2010 and March 2021, 62 PC patients who underwent SEMS exchange to FC (n = 34) or UC (n = 28) for RBO were retrospectively analyzed. Patient characteristics, OS, time to RBO (TRBO), and stent-related adverse events were compared between the FC and UC groups. Cox’s proportional hazard model was used to identify risk factors for RBO with the 2nd SEMS.

Results

There was a significant difference between the FC and UC groups only in the 2nd SEMS diameter. Median OS and TRBO were 195 and 238 days in FC patients and 306 and 455 days in UC patients, respectively, with no significant differences between the two groups. No significant differences were observed in the stent-related adverse event rate. In multivariate analyses, only the 2nd SEMS diameter was significant (P = 0.009). Median TRBO were 455, 238, and 103 days in 10-mm UC, 10-mm FC, and 8-mm UC patients, with 10-mm UC patients having significantly longer TRBO than 10-mm FC and 8-mm UC patients (P = 0.020 and 0.001).

Conclusion

SEMS exchange to 10-mm UC may be appropriate for RBO of PC with FC as the 1st SEMS.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Kunio Kataoka, Eizaburo Ohno, Takuya Ishikawa, Yasuyuki Mizutani, Tadashi Iida, Kazuhiro Furukawa, Masanao Nakamura, Takashi Honda, Masatoshi Ishigami & Mitsuhiro Fujishiro

  2. Department of Endoscopy, Nagoya University Hospital, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Hiroki Kawashima

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  1. Kunio Kataoka
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Contributions

Conception and design: KK, HK, EO, TI. Analysis and interpretation of data: KK, HK, EO, TI. Drafting of the article: KK, HK, EO, TI, YM, TI, KF, MN, TH, MI. Critical revision of the article for important intellectual content: MF. Final approval of the article: All authors.

Corresponding author

Correspondence to Hiroki Kawashima.

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Disclosures

Drs. Kunio Kataoka, Hiroki Kawashima, Eizaburo Ohno, Takuya Ishikawa, Yasuyuki Mizutani, Tadashi Iida, Kazuhiro Furukawa, Masanao Nakamura, Takashi Honda, Masatoshi Ishigami, and Mitsuhiro Fujishiro have no conflicts of interest or financial ties to disclose.

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Kataoka, K., Kawashima, H., Ohno, E. et al. Comparison of outcomes between secondary fully covered and uncovered self-expandable metal stents in the treatment of recurrent biliary obstruction of pancreatic cancer. Surg Endosc 36, 5676–5683 (2022). https://doi.org/10.1007/s00464-021-08981-2

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