Objectives: Expandable metallic stents (EMSs) are widely used to palliate unresectable malignant biliary obstructions. The efficacy and safety of EMS in patients receiving gemcitabine (GEM) for unresectable pancreatic cancer is evaluated.
Methods: Data for 147 patients with unresectable pancreatic cancer were studied retrospectively: 52 received GEM without EMS, 36 received GEM with EMS, 27 received only best supportive care (BSC) without EMS, and 32 received BSC with EMS.
Results: Expandable metallic stent did not increase adverse effects (>grade 2) caused by GEM (P = 0.809), and the rates of infections other than cholangitis and cholecystitis were neither increased by GEM nor by EMS (P = 0.287). Cholangitis and cholecystitis occurred exclusively in patients with EMS and was managed successfully. Tumor extension, good performance status, and GEM, but not EMS, were shown to affect survival. Stent-related complications were observed in 26 patients (72%) receiving GEM and in 17 patients (53%) with BSC (P = 0.133). Multivariate analyses revealed no predictors for stent-related complications, although the use of covered EMS and good performance status were associated with longer stent patency. Gemcitabine affected neither stent-related complications nor stent patency.
Conclusions: Expandable metallic stent placement is safe and effective in patients with unresectable pancreatic cancer receiving GEM. Gemcitabine improves survival irrespective of EMS placement.