Risk of tumor dislocation following self-expandable metallic stents placement, associated pathological pattern and survival for pancreatic adenocarcinoma. Results of a French multicenter study

Abstract

Rational: Biliary self-expandable metallic stents (bSEMSs) have been proven to have longer stent patency than plastic stents (bPS) in malignant biliary obstruction and is now advise as a standard practice. The risk of tumor dislocation following bSEMS placement and associated pathological pattern has never been evaluated. This study aimed to evaluate the impact of insertion of bSEMS on pathological pattern and long-term survival of patients who underwent pancreaticoduodenectomy (PD) for resectable pancreatic ductal adenocarcinoma (PDAC). Methods: A multicenter observational study was performed using a common database of patients with opereted resectable PDAC from sixteen high-volume centers in France between 2009 and 2015. Results: Of 597 patients who underwent PD for PDAC, 197(62%) underwent preoperative endoscopic biliary drainage, including 105(51%) with SEMS and 92(49%) with PS. The patients without biliary drainage had a significantly better median overall survival (34,9 vs 29,5 months; p=0.004) and recurrence free survival (24,6 vs 189, months; p=0.002) than those with bSEMS. Patients with bPS had intermediate survivals without any difference with the 2 other groups. Perineural (p=0.001) and lymphovascular (p=0.029) invasion were significantly more frequent in patients with bSEMS, but lymph node involvement and ratio were not. Multivariate analysis showed that biliary drainage, lymph node involvement and the absence of adjuvant treatment were independently associated with poorer overall survival. Conclusions: Use of SEMS, but not PS, was associated with a poorer prognosis among patients who underwent PD for PDAC, possibly related to tumor dislocation following SEMS placement. Neoadjuvant therapy in that setting should be discussed systematically.