Long-term Outcome of Biliary and Duodenal Stents in Palliative Treatment of Patients with Unresectable Adenocarcinoma of the Head of Pancreas View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2006-04-01

AUTHORS

Frédérique Maire, Pascal Hammel, Philippe Ponsot, Alain Aubert, Dermot O'Toole, Olivia Hentic, Philippe Levy, Philippe Ruszniewski

ABSTRACT

BACKGROUND: Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown. AIM: To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer. PATIENTS AND METHODS: All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival. RESULTS: One hundred patients, median age 65 yr (32-85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7-29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4-21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5-15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment. CONCLUSION: Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival. More... »

PAGES

735

Identifiers

URI

http://scigraph.springernature.com/pub.10.1111/j.1572-0241.2006.00559.x

DOI

http://dx.doi.org/10.1111/j.1572-0241.2006.00559.x

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1022593035

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/16635221


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32 schema:description BACKGROUND: Life expectancy in patients with unresectable pancreatic cancer has improved by using new chemotherapeutic regimens. Biliary and digestive stenoses can be endoscopically treated in most cases. However, long-term efficacy of these stenting procedures remains unknown. AIM: To evaluate the incidence of biliary and duodenal stenoses as well as technical success and short- and long-term patency of endoscopically deployed stents in patients with unresectable pancreatic cancer. PATIENTS AND METHODS: All consecutive patients with unresectable cancer of the pancreatic head seen between January 1999 and September 2003 in our center were retrospectively studied. Patients with biliary and/or duodenal stenoses underwent endoscopic stent insertion as first intention therapy. Outcomes included technical and clinical success, stent patency, and survival. RESULTS: One hundred patients, median age 65 yr (32-85), with locally advanced (62%) or metastatic (38%) pancreatic cancer were studied. Eighty-three percent received at least one line of chemotherapy. The actuarial median survival was 11 months (0.7-29.3). Biliary and duodenal stenoses occurred in 81 and 25 patients, respectively. A biliary stent was successfully placed in 74 patients (91%). When a self-expandable metallic stent was first introduced (N = 59), a single stent was sufficient in 41 patients (69%) (median duration of stent patency 7 months (0.4-21.1)). Duodenal stenting was successful in 24 patients (96%); among them, 96% required a single stent (median duration of stent patency 6 months [0.5-15.7]). In the 23 patients who developed both biliary and duodenal stenoses, combined stenting was successful in 91% of cases. No major complication or death occurred related to endoscopic treatment. CONCLUSION: Endoscopic palliative treatment of both biliary and duodenal stenoses is safe and effective in the long term, including in patients with combined obstructions. Use of such palliative management is justified as repeat procedures are rarely required even in patients who have a long survival.
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40 actuarial median survival
41 adenocarcinoma
42 age 65 yr
43 biliary
44 biliary stents
45 cancer
46 cases
47 center
48 chemotherapeutic regimens
49 chemotherapy
50 clinical success
51 combined stenting
52 complications
53 consecutive patients
54 death
55 digestive stenoses
56 duodenal stenoses underwent endoscopic stent insertion
57 duodenal stenosis
58 duodenal stent
59 duodenal stenting
60 efficacy
61 endoscopic stent insertion
62 endoscopic treatment
63 expectancy
64 first intention therapy
65 head
66 head of pancreas
67 incidence
68 insertion
69 intention therapy
70 life expectancy
71 lines
72 lines of chemotherapy
73 long term
74 long-term efficacy
75 long-term outcomes
76 long-term patency
77 longer survival
78 major complications
79 management
80 median age 65 yr
81 median survival
82 metallic stents
83 metastatic pancreatic cancer
84 method
85 months
86 most cases
87 new chemotherapeutic regimens
88 obstruction
89 outcomes
90 palliative management
91 palliative treatment
92 pancreas
93 pancreatic cancer
94 pancreatic head
95 patency
96 patients
97 percent
98 procedure
99 regimens
100 repeat procedures
101 self-expandable metallic stents
102 single stent
103 stenoses underwent endoscopic stent insertion
104 stenosis
105 stent insertion
106 stent patency
107 stenting
108 stents
109 success
110 such palliative management
111 survival
112 technical success
113 terms
114 therapy
115 treatment
116 underwent endoscopic stent insertion
117 unresectable adenocarcinoma
118 unresectable cancer
119 unresectable pancreatic cancer
120 use
121 yr
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