Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

Abstract

Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC). Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p = 0.01). The complication rates due to biliary drainage were 0% (0/9) with metallic stents and 72.7% (8/11) with plastic stents (p = 0.01). Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p = 0.012). There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

Figures

Figure 1

Endoscopic biliary drainage. (a), (b) X-ray image and endoscopic image of plastic stent. (c), (d) X-ray image and endoscopic image of metallic stent.

Figure 2

Representative computed tomography images of borderline resectable pancreatic cancer and locally advanced unresectable pancreatic cancer. (a), (b) Tumor in the pancreatic head slightly abutting the portal vein and invading less than half of the circumference of the superior mesenteric artery (borderline resectable pancreatic cancer). (c), (d) Tumor in the pancreatic head invading less than half the circumference of the superior mesenteric artery (locally advanced unresectable pancreatic cancer).

Figure 3

Cumulative rate of complications by stent type. Cumulative rate of complications was investigated using the Kaplan-Meier method. The rate of complications on day 60 was 45% for PS and 0% for MS. On day 90, it was 60% for PS and 0% for MS. Cumulative rate for complications was significantly lower for MS than for PS. Statistical analysis was performed using the log-rank test. MS, metallic stent; PS, plastic stent. The solid line is the MS group; the wavy line is the PS group.