S. A. Hartman1, L. Demyan1, E. Gazzara1,5, N. Lad1,3, S. Pasha3, J. Fallon1, K. Raphael6, J. Bucobo6, P. Benias6, M. Melis1,2, A. Trindade6, E. Newman1,2, D. DePeralta1,3, M. Weiss1,3,4, O. Standring1,5 1Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department Of Surgery, Manhhasset, NY, USA 2Lenox Hill Hospital, Department Of Surgical Oncology, New York, NY, USA 3North Shore University And Long Island Jewish Medical Center, Department Of Surgical Oncology, Manhasset, NY, USA 4Feinstein Institutes for Medical Research, Institute Of Cancer Research, Manhasset, NY, USA 5Lustgarten Foundation Pancreatic Cancer Research Laboratory at Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA 6Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department Of Gastroenterology, Manhasset, NY, USA
Introduction: Neoadjuvant therapy (NAT) is increasingly utilized in the management of patients with pancreatic ductal adenocarcinoma (PDAC). Many patients undergoing NAT require biliary decompression with stent placement and, as prior studies have shown, plastic stents (PS) have a greater tendency towards stent-related complications than metal stents (MS). This study tests the hypothesis that the use of plastic stents for biliary decompression will not only lead to more stent-related complications but also to longer, more frequent interruptions in NAT than metal stents.
Methods: This is a single-institution retrospective review of 1,295 patients diagnosed with PDAC that were treated between 2013 and 2022. Patients that underwent biliary decompression with PS or MS and underwent NAT were included in the analysis. Chi-squared analysis was used for categorical variables and t-test was used for continuous variables. Statistical significance was set at p<0.05.
Results: A total of 174 patients with PDAC received NAT of which 73 patients required biliary stenting. 45 patients initially received metal stents and 28 received plastic stents. There was no significant difference between the groups in regards to gender, race, baseline ECOG, baseline bilirubin, and surgical resectability. However, MS patients were older than PS patients with a mean age of 71 and 66 years respectively (p=0.046). 67% of PS stent recipients had stent-related complications, such as occlusion, migration and acute cholecystitis, compared to 26% in the MS group (p=0.001) where complications were exclusively occlusive in nature. 57% of PS patients required stent replacement during the neoadjuvant period compared to 24% of MS patients (p=0.005). Of the PS patients, 54.2% had a stent-related interruption in their NAT compared to 19% of patients in the MS group (p=0.003). The average delay of treatment during the neoadjuvant period was 16 days in the plastic group and 13 days in the metal group although this result was not significant (p=0.55). In patients that had stent-related complications, the mean time to surgery was significantly longer than those who did not have stent-related complications (284 days and 182 days respectively, p=0.001).
Conclusion: For patients with PDAC who required biliary decompression in the neoadjuvant setting, the use of plastic stents led to more stent-related complications and therefore longer delays to surgery. They also had more overall interruptions in NAT than metal stents. Future studies are needed to evaluate the relationship between PS replacement and cost of hospitalization, financial toxicity related to additional hospital visits, and overall quality of life.
