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Stenting for Biliary Drainage in Pancreatic Cancer Studied

Researchers say pre-surgery stenting increases complications without improving surgery outcome

WEDNESDAY, Jan. 13 (HealthDay News) -- Placing a stent to facilitate biliary drainage prior to surgery in patients with cancer of the pancreatic head and obstructive jaundice increases complication rates and does not improve the outcome of the surgery, according to a study in the Jan. 14 New England Journal of Medicine.

Niels A. van der Gaag, M.D., of the Academic Medical Center in Amsterdam, Netherlands, and colleagues randomized 202 patients with the conditions to be treated with either preoperative biliary drainage via endoscopic placement of a plastic stent for four to six weeks prior to having surgery, or surgery alone within a week of diagnosis. The researchers noted complications within 120 days from randomization.

At study end point, the researchers found that 74 percent of the patients who had the preoperative biliary drainage had complications such as pancreatitis, cholangitis, perforation, hemorrhage or stent problems, compared to 39 percent in the surgery-only group. Among the patients in whom the preoperative biliary drainage was successful (94 percent), 46 percent had complications. Complications related to surgery occurred in 47 percent of the preoperative biliary drainage patients and 37 percent in the surgery-alone group. The groups did not differ for mortality or length of stay in the hospital.

"In light of our poor results with plastic stents, preoperative biliary drainage during the period of neoadjuvant treatment might be best achieved with metal stents, which have a higher patency rate than plastic stents and do not affect the outcome of surgery," the authors write.

Authors of the study and editorial reported receiving lecture and/or consulting fees from several pharmaceutical companies.

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