Bridge to surgery using partially covered self-expandable metal stents (PCMS) in malignant biliary stricture

An acceptable paradigm?

George H. Pop, James A. Richter, Bryan Sauer, Michele E. Relian, Henry C. Ho, Reid B. Adams, Todd Bauer, Vanessa M. Shami, Melissa Lapinska, Michel Kahaleh

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background and aim Partially covered self-expanding metal stents (PCMS) have been extensively used for palliation of malignant distal biliary stricture. Many centers have been using them as a bridge to surgery (BTS) regardless of resectability with or without eventual neoadjuvant therapy. We analyzed the outcome of all patients receiving PCMS and subsequently referred for surgery in our institution. Methods Our prospectively established pancreaticobiliary database was retrospectively analyzed to retrieve all patients with malignant biliary stricture who underwent PCMS placement and subsequently went for curative surgical attempt at our institution. Cancer type and staging, adverse events related to stent placement or surgery, type of surgery performed, time between stenting and surgery, length of postoperative hospitalization, and postoperative follow-up were recorded. Results 27 patients (21 men; median age 66 years, range 39-82 years) received PCMS. Indications for placement included biliary stricture related to pancreatic cancer (n = 23) or other malignancies (n = 4). Median time between stenting and surgery was 32 days (range 6-569 days). Median time of hospitalization post surgery was 7 days (1-40 days). All patients underwent exploratory laparoscopy, followed in 9 (33.3%) by Whipple procedure with uneventful removal of the PCMS. Eighteen patients (66.6%) had their attempted curative resection terminated early due to intraoperative evidence of metastatic spread, with 8 (30%) patients undergoing peritoneal or liver metastasis biopsy. PCMS were left in place in those 18 patients. Complications related to PCMS in the bridge-tosurgery period included migration (n = 2, 7.4%) and tissue overgrowth (n = 1, 3.4%), all of them managed by endoscopic removal and replacement with PCMS. Median follow-up post surgery was 210 days (range 9-1,642 days). Conclusion PCMS are an appropriate BTS option. For resectable patients, PCMS results in biliary drainage and allows for neoadjuvant treatment without portending subsequent curative resection (Whipple). For unresectable patients, long-term biliary drainage is provided by PCMS.

Original languageEnglish (US)
Pages (from-to)613-618
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

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Pathologic Constriction
Neoadjuvant Therapy
Stents
Drainage
Hospitalization
Self Expandable Metallic Stents
Neoplasm Staging
Pancreatic Neoplasms
Laparoscopy
Metals
Databases
Neoplasm Metastasis
Biopsy
Liver
Neoplasms

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Bridge to surgery using partially covered self-expandable metal stents (PCMS) in malignant biliary stricture : An acceptable paradigm? / Pop, George H.; Richter, James A.; Sauer, Bryan; Relian, Michele E.; Ho, Henry C.; Adams, Reid B.; Bauer, Todd; Shami, Vanessa M.; Lapinska, Melissa; Kahaleh, Michel.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 25, No. 2, 01.02.2011, p. 613-618.

Research output: Contribution to journalArticle

Pop, George H. ; Richter, James A. ; Sauer, Bryan ; Relian, Michele E. ; Ho, Henry C. ; Adams, Reid B. ; Bauer, Todd ; Shami, Vanessa M. ; Lapinska, Melissa ; Kahaleh, Michel. / Bridge to surgery using partially covered self-expandable metal stents (PCMS) in malignant biliary stricture : An acceptable paradigm?. In: Surgical Endoscopy and Other Interventional Techniques. 2011 ; Vol. 25, No. 2. pp. 613-618.
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abstract = "Background and aim Partially covered self-expanding metal stents (PCMS) have been extensively used for palliation of malignant distal biliary stricture. Many centers have been using them as a bridge to surgery (BTS) regardless of resectability with or without eventual neoadjuvant therapy. We analyzed the outcome of all patients receiving PCMS and subsequently referred for surgery in our institution. Methods Our prospectively established pancreaticobiliary database was retrospectively analyzed to retrieve all patients with malignant biliary stricture who underwent PCMS placement and subsequently went for curative surgical attempt at our institution. Cancer type and staging, adverse events related to stent placement or surgery, type of surgery performed, time between stenting and surgery, length of postoperative hospitalization, and postoperative follow-up were recorded. Results 27 patients (21 men; median age 66 years, range 39-82 years) received PCMS. Indications for placement included biliary stricture related to pancreatic cancer (n = 23) or other malignancies (n = 4). Median time between stenting and surgery was 32 days (range 6-569 days). Median time of hospitalization post surgery was 7 days (1-40 days). All patients underwent exploratory laparoscopy, followed in 9 (33.3{\%}) by Whipple procedure with uneventful removal of the PCMS. Eighteen patients (66.6{\%}) had their attempted curative resection terminated early due to intraoperative evidence of metastatic spread, with 8 (30{\%}) patients undergoing peritoneal or liver metastasis biopsy. PCMS were left in place in those 18 patients. Complications related to PCMS in the bridge-tosurgery period included migration (n = 2, 7.4{\%}) and tissue overgrowth (n = 1, 3.4{\%}), all of them managed by endoscopic removal and replacement with PCMS. Median follow-up post surgery was 210 days (range 9-1,642 days). Conclusion PCMS are an appropriate BTS option. For resectable patients, PCMS results in biliary drainage and allows for neoadjuvant treatment without portending subsequent curative resection (Whipple). For unresectable patients, long-term biliary drainage is provided by PCMS.",
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T2 - An acceptable paradigm?

AU - Pop, George H.

AU - Richter, James A.

AU - Sauer, Bryan

AU - Relian, Michele E.

AU - Ho, Henry C.

AU - Adams, Reid B.

AU - Bauer, Todd

AU - Shami, Vanessa M.

AU - Lapinska, Melissa

AU - Kahaleh, Michel

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N2 - Background and aim Partially covered self-expanding metal stents (PCMS) have been extensively used for palliation of malignant distal biliary stricture. Many centers have been using them as a bridge to surgery (BTS) regardless of resectability with or without eventual neoadjuvant therapy. We analyzed the outcome of all patients receiving PCMS and subsequently referred for surgery in our institution. Methods Our prospectively established pancreaticobiliary database was retrospectively analyzed to retrieve all patients with malignant biliary stricture who underwent PCMS placement and subsequently went for curative surgical attempt at our institution. Cancer type and staging, adverse events related to stent placement or surgery, type of surgery performed, time between stenting and surgery, length of postoperative hospitalization, and postoperative follow-up were recorded. Results 27 patients (21 men; median age 66 years, range 39-82 years) received PCMS. Indications for placement included biliary stricture related to pancreatic cancer (n = 23) or other malignancies (n = 4). Median time between stenting and surgery was 32 days (range 6-569 days). Median time of hospitalization post surgery was 7 days (1-40 days). All patients underwent exploratory laparoscopy, followed in 9 (33.3%) by Whipple procedure with uneventful removal of the PCMS. Eighteen patients (66.6%) had their attempted curative resection terminated early due to intraoperative evidence of metastatic spread, with 8 (30%) patients undergoing peritoneal or liver metastasis biopsy. PCMS were left in place in those 18 patients. Complications related to PCMS in the bridge-tosurgery period included migration (n = 2, 7.4%) and tissue overgrowth (n = 1, 3.4%), all of them managed by endoscopic removal and replacement with PCMS. Median follow-up post surgery was 210 days (range 9-1,642 days). Conclusion PCMS are an appropriate BTS option. For resectable patients, PCMS results in biliary drainage and allows for neoadjuvant treatment without portending subsequent curative resection (Whipple). For unresectable patients, long-term biliary drainage is provided by PCMS.

AB - Background and aim Partially covered self-expanding metal stents (PCMS) have been extensively used for palliation of malignant distal biliary stricture. Many centers have been using them as a bridge to surgery (BTS) regardless of resectability with or without eventual neoadjuvant therapy. We analyzed the outcome of all patients receiving PCMS and subsequently referred for surgery in our institution. Methods Our prospectively established pancreaticobiliary database was retrospectively analyzed to retrieve all patients with malignant biliary stricture who underwent PCMS placement and subsequently went for curative surgical attempt at our institution. Cancer type and staging, adverse events related to stent placement or surgery, type of surgery performed, time between stenting and surgery, length of postoperative hospitalization, and postoperative follow-up were recorded. Results 27 patients (21 men; median age 66 years, range 39-82 years) received PCMS. Indications for placement included biliary stricture related to pancreatic cancer (n = 23) or other malignancies (n = 4). Median time between stenting and surgery was 32 days (range 6-569 days). Median time of hospitalization post surgery was 7 days (1-40 days). All patients underwent exploratory laparoscopy, followed in 9 (33.3%) by Whipple procedure with uneventful removal of the PCMS. Eighteen patients (66.6%) had their attempted curative resection terminated early due to intraoperative evidence of metastatic spread, with 8 (30%) patients undergoing peritoneal or liver metastasis biopsy. PCMS were left in place in those 18 patients. Complications related to PCMS in the bridge-tosurgery period included migration (n = 2, 7.4%) and tissue overgrowth (n = 1, 3.4%), all of them managed by endoscopic removal and replacement with PCMS. Median follow-up post surgery was 210 days (range 9-1,642 days). Conclusion PCMS are an appropriate BTS option. For resectable patients, PCMS results in biliary drainage and allows for neoadjuvant treatment without portending subsequent curative resection (Whipple). For unresectable patients, long-term biliary drainage is provided by PCMS.

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