Abstract
BackgroundAdvanced pancreatic cancer is accompanied not only by bile duct obstruction, but also occasionally by duodenal obstruction. With new advances in chemotherapy and improvement in the management of stent dysfunction, the life expectancy of patients with pancreatic cancer has increased. This study aimed to evaluate the efficacy and safety of chemotherapy for advanced pancreatic cancer, as well as to analyze the prognostic factors, following endoscopic double stenting.MethodsThis retrospective study was conducted from January 1, 2007 to October 31, 2015 at an academic center. Fifty consecutive patients with pancreatic cancer who had undergone endoscopic double stenting, comprising duodenal and biliary stenting, were analyzed. We reviewed the patients records and analyzed the data of stent dysfunction rates after double stenting, reintervention for stent dysfunction, chemotherapy after double stenting, adverse events associated with chemotherapy after double stenting, survival times following double stenting, and overall survival times. The hospital’s institutional review board for human research approved this study.ResultsThe overall survival time and the survival time following double stenting were 10.9 months (IQR 6.0–18.4 months) and 2.4 months (IQR 1.4–5.2 months), respectively. After double stenting, duodenal stent dysfunction occurred in 6 patients (12%), and biliary stent dysfunction occurred in 12 patients (24%), respectively. All patients who experienced stent dysfunction underwent endoscopic reintervention, and all of the procedures were successful. Twenty-one (42%) patients were treated with chemotherapy post double stenting; 9 patients received chemotherapy as a first-line treatment, 9 as a second-line treatment, and 3 as a third-line treatment. During chemotherapy, 8 (38%) patients had grade 3–4 adverse events, which were manageable. Chemotherapy post double stenting (OR, 0.19; 95% CI, 0.059–0.60; P = .0051), reintervention for biliary stent dysfunction (OR, 0.21; 95% CI, 0.081–0.50; P = .0002), and performance status (< 2) (OR, 0.28; 95% CI, 0.098–0.71; P = .0064) were significant prognostic factors after double stenting.ConclusionsSystemic chemotherapy was manageable, even in patients with double stenting. Chemotherapy after double stenting and appropriate reintervention for stent obstructions potentially prolonged the survival of patients with advance pancreatic cancer.
Highlights
Advanced pancreatic cancer is accompanied by bile duct obstruction, and occasionally by duodenal obstruction
Control of clinical symptoms associated with advanced cancer, such as gastric outlet obstruction (GOO) and obstructive jaundice, is required
Patients Fifty consecutive patients with pancreatic cancer who had undergone endoscopic double stenting, comprising duodenal stenting (DuS) and biliary stenting (BS), from January 1, 2007 to October 31, 2015 at our institution, were retrospectively analyzed. The records of these patients were reviewed, and the following data were analyzed: patient characteristics, duodenal stenosis sites, timings of double stenting, selected Biliary drainage (BD) methods, stent patency periods, technical and clinical success rates for reintervention, chemotherapy after double stenting, adverse events associated with chemotherapy after double stenting, time from initial diagnosis to double stenting, survival times following double stenting, and overall survival times
Summary
Advanced pancreatic cancer is accompanied by bile duct obstruction, and occasionally by duodenal obstruction. With new advances in chemotherapy and improvement in the management of stent dysfunction, the life expectancy of patients with pancreatic cancer has increased. Advanced pancreatic cancer is accompanied by bile duct obstruction, and sometimes by duodenal obstruction [2, 3]. These cause symptoms such as nausea, vomiting, anorexia, and weight loss, resulting in a marked decline in quality of life. With the advent of new oncologic therapies and improvement in the management of adverse events of chemotherapy, the life expectancy of patients with pancreatic cancer has steadily increased [10,11,12]. Control of clinical symptoms associated with advanced cancer, such as gastric outlet obstruction (GOO) and obstructive jaundice, is required
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