A recent trial concluded that preoperative biliary drainage (PBD) in patients with pancreatic head cancer increases complications but is unlikely to change clinical practice. The difference in the outcomes reported was because of excessive complications in the PBD group using plastic stents. We argue that these patients need treatment in regional pancreatic cancer centers using low-occlusion metal stents.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$209.00 per year
only $17.42 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
References
Wang, Q., Gurusamy, K. S., Lin, H., Xie, X. & Wang, C. Preoperative biliary drainage for obstructive jaundice. Cochrane Database Syst. Rev, Issue 3. Art. No.: CD005444. doi:10.1002/14651858.CD005444.pub2 (2008).
van der Gaag, N. A. et al. Preoperative biliary drainage for cancer of the head of the pancreas. N. Engl. J. Med. 362, 129–137 (2010).
Baron, T. H. & Kozarek, R. A. Preoperative biliary stents in pancreatic cancer--proceed with caution. N. Engl. J. Med. 362, 170–172 (2010).
Chen, V. K., Arguedas, M. R. & Baron, T. H. Expandable metal biliary stents before pancreaticoduodenectomy for pancreatic cancer: a Monte-Carlo decision analysis. Clin. Gastroenterol. Hepatol. 3, 1229–1237 (2005).
Lawrence, C., Howell, D. A., Conklin, D. E., Stefan, A. M. & Martin, R. F. Delayed pancreaticoduodenectomy for cancer patients with prior ERCP-placed, nonforeshortening, self-expanding metal stents: a positive outcome. Gastrointest. Endosc. 63, 804–807 (2006).
Halloran, C. M. et al. Carbohydrate antigen 19.9 accurately selects patients for laparoscopic assessment to determine resectability of pancreatic malignancy. Br. J. Surg. 95, 453–459 (2008).
Balcom, J. H. 4th, Rattner, D. W., Warshaw, A. L., Chang, Y. & Fernandez-del Castillo, C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch. Surg. 136, 391–398 (2001).
Winter, J. M. et al. 1,423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J. Gastrointest. Surg. 10, 1199–1210 (2006).
Müller, S. A. et al. Vascular resection in pancreatic cancer surgery: survival determinants. J. Gastrointest. Surg. 13, 784–792 (2009).
Smith, R. A. et al. Preoperative resolution of jaundice following biliary stenting predicts more favorable early survival in resected pancreatic ductal adenocarcinoma. Ann. Surg. Oncol. 15, 3138–3146 (2008).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing financial interests.
Rights and permissions
About this article
Cite this article
Neoptolemos, J., Halloran, C. PBD—better stents in specialized centers are needed. Nat Rev Clin Oncol 7, 244–246 (2010). https://doi.org/10.1038/nrclinonc.2010.45
Issue Date:
DOI: https://doi.org/10.1038/nrclinonc.2010.45
This article is cited by
-
PBD treatment of cancer of the head of the pancreas
Nature Reviews Clinical Oncology (2010)
-
Authors' reply: PBD treatment of cancer of the head of the pancreas
Nature Reviews Clinical Oncology (2010)
