Stent patency using competing risk model in unresectable pancreatic cancers inserted with biliary self‐expandable metallic stent

Eum, Young Ook; Kim, Yong Tae; Lee, Sang Hyub; Hwang, Jin Hyeok; Yoon, Won Jae; Ryu, Ji Kon; Yoon, Yong Bum; Han, Joon Koo; Yoon, Chang Jin; Cho, Jung Hwa; Choi, Yunhee

doi:10.1111/j.1443-1661.2012.01335.x

Cited by 13 publications

(6 citation statements)

References 23 publications

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“…The metastatic stage was also found to be associated with SEMS patency in this study, which is consistent with the finding of a previous study reporting that stent patency is associated with the cancer stage in patients with unresectable pancreatic cancer (27)(28)(29)(30). An advanced stage of pancreatic cancer may influence SEMS patency due to early death or loss to follow-up of the patients.…”

Section: Discussionsupporting

confidence: 93%

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Ahn¹,

Ahn²,

Park³

et al. 2022

J Gastrointest Oncol

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Background: Chemotherapy reportedly affects the patency of self-expandable metal stents (SEMSs) in patients with cancer. However, knowledge regarding the association between SEMS patency and progression-free survival (PFS) remains limited. This study aimed to assess PFS and SEMS patency in patients with advanced pancreatic cancer.Methods: Between January 2012 and June 2021, 74 patients with locally advanced or metastatic pancreatic cancer (MPC) were enrolled in the study. Patients received gemcitabine plus nab-paclitaxel (GnP) or fluorouracil, leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) as initial chemotherapy and SEMS within 1 month before or after the initial chemotherapy. Longer PFS was defined as PFS ≥7 months.Results: This study enrolled 38 male patients (51.4%); the mean age was 66.2 [95% confidence interval (CI), 63.7-68.6] years. Of the patients, 46 (62.2%) had MPC and 58 (78.4%) received FOLFIRINOX as the initial chemotherapy. Of the patients, 61 (82.4%) underwent endoscopic SEMS insertion. The median stent patency and PFS were 6.9 [interquartile range (IQR), 4.5-12.9] and 6.4 (IQR, 4.2-12.5) months, respectively; the median overall survival (OS) was 10.5 (IQR, 6.7-16.5) months. Of the clinical parameters assessed using multivariate analysis, shorter PFS [PFS <7 months; hazard ratio (HR), 2.117; 95% CI, 1.020-4.393; P=0.044] and metastatic cancer (HR, 2.414; 95% CI, 1.159-5.018; P=0.019) were found to be associated with shorter SEMS patency. The median SEMS patency in patients with longer PFS and those with shorter PFS was 14.3 and 7.0 months (P=0.012), respectively, and that in patients with locally advanced cancer and those with metastatic cancer was 16.7 and 7.0 months (P=0.006), respectively. The coefficient of determination between stent patency and PFS was 0.624.Conclusions: SEMS patency may be associated with PFS in patients with advanced pancreatic cancer who receive GnP or FOLFIRINOX.

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Section: Discussionsupporting

confidence: 93%

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Ahn¹,

Ahn²,

Park³

et al. 2022

J Gastrointest Oncol

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“…Although there were no significant differences in causative diseases among the three groups, the prognosis and tumor progression pattern, which may affect stent patency, vary for each malignancy. Second, this study is retrospective and has potential biases [ 38 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Partially covered metal stents have longer patency than uncovered and fully covered metal stents in the management of distal malignant biliary obstruction: a retrospective study

et al. 2017

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BackgroundSelf-expandable metal stents (SEMSs) are widely used for malignant biliary obstructions. Nitinol-covered SEMSs have been developed to improve stent patency. Currently, SEMSs may be uncovered, partially covered, or fully covered; however, there is no consensus on the best stent type for the management of malignant distal biliary obstruction (MDBO).MethodsPatients with unresectable MDBO receiving SEMS (Wallflex™) were retrospectively analyzed. Time to recurrent biliary obstruction (TRBO) and survival time were compared among the three types of SEMSs. Univariate and multivariate analyses were performed to identify risk factors for stent dysfunction.ResultsIn total, 101 patients received SEMSs for unresectable MDBO (44 uncovered, 28 partially covered, and 29 fully covered SEMSs). Median survival time was 200, 168, and 276 days in the uncovered, partially covered, and fully covered SEMSs groups, respectively. There were no differences in survival among the three groups. Median TRBO was 199, 444, and 194 days in the uncovered, partially covered, and fully covered SEMSs groups, respectively. Partially covered SEMSs had longer TRBO than uncovered (p = 0.013) and fully covered (p = 0.010) SEMSs. Tumor ingrowth occurred only with uncovered SEMSs and stent migration occurred only with fully covered SEMSs. Multivariate analyses confirmed that partially covered SEMSs have lower risk of dysfunction.ConclusionsPartially covered SEMSs with a proximal uncovered flared end have longer patency than uncovered and fully covered SEMSs by preventing tumor ingrowth and stent migration.

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“…The use of RFA in the biliary tract is also limited due to the possibility of biliary fistulas and bile duct adhesion. A new bipolar catheter can avoid the aforementioned problems and has been demonstrated to be successful and safe for palliative therapy for malignant biliary occlusion[12]. …”

Section: Discussionmentioning

confidence: 99%

Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result

Xia

Gong

et al. 2017

WJG

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AIMTo assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction.METHODSWe specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter.RESULTSFollowing the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to follow-up. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 ± 65 μmol/L and 63 ± 29 μmol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients’ stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d.CONCLUSIONThis preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach.

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Stent patency using competing risk model in unresectable pancreatic cancers inserted with biliary self‐expandable metallic stent

Abstract: The patency of biliary SEMS in unresectable pancreatic cancers might be affected by the stage. Lower cancer stage and normalized bilirubin are associated with longer survival.

Cited by 13 publications

References 23 publications

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Association between progression-free survival and metal stent patency in patients with advanced pancreatic cancer

Partially covered metal stents have longer patency than uncovered and fully covered metal stents in the management of distal malignant biliary obstruction: a retrospective study

Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result

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