Preoperative Biliary Stents in Pancreatic Cancer

Introduction

Pancreatic cancer is the second most common digestive cancer and the fourth leading cause of cancer death in the U.S. for both men and women; it is estimated that pancreatic cancer accounted for 3% of all diagnosed cancers and 6% of all cancer-related deaths in 2009. The 5-year survival rate for all patients diagnosed with pancreatic cancer is less than 5%. Approximately 80% of all pancreatic cancer occurs in the head and the only potential curative treatment option for these patients is curative intent surgery (CIS) by pancreaticoduodenectomy (Whipple operation). Fifteen to thirty percent of patients are candidates for CIS.

Abstract

Pancreatic cancer is a common disease and surgical resection is the only potential curative treatment option. Biliary obstruction nearly always occurs in patients with cancer of the pancreatic head. Because obstructive jaundice potentially increases surgical complications following pancreaticoduodenectomy, preoperative biliary drainage has been advocated. Endoscopic and percutaneous stent placement techniques have been used and in experienced centers the technical success rates for biliary decompression are high. Routine preoperative biliary drainage for obstructive jaundice and pancreatic cancer is controversial. Prospective studies have demonstrated that complications related to preoperative biliary drainage using traditional plastic endoprostheses increases the morbidity following pancreaticoduodenectomy. Self-expandable metal stents provide longer patency than traditional plastic stents and could reduce stent-related complication rates following preoperative biliary decompression, especially when surgery is delayed. Selected patients with deep jaundice, those in need of neoadjuvant treatment prior to curative intent surgery, are the candidates who benefit most from temporary biliary drainage. Patients with pancreatic cancer presenting with cholangitis need early, urgent preoperative biliary decompression.

Keywords

periampullary pancreatic tumors, pancreatic cancer, jaundice, biliary obstruction, preoperative drainage, stent