Survival impact of pancreatic stenting in unresected pancreatic head cancer with obstructive jaundice: a retrospective cohort study

Background: Malnutrition is common in patients with pancreatic head cancer, which can diminish their tolerance to anti-cancer treatments. Pancreatic duct blockage is one of the contributing factors leading to malnutrition. Objectives: This study aimed to clarify whether pancreatic stenting offers a survival benefit in patients with unresected pancreatic head cancer. Design: Retrospective observational study. Methods: Patients with newly diagnosed pancreatic cancers who received endoscopic retrograde cholangiopancreatography (ERCP) because of biliary tract obstruction were collected from a hospital-based cancer registry between 2007 and 2021. Individuals who underwent tumor resection or bypass surgery following ERCP were excluded. The primary outcome was the 1-year survival rate in patients with and without a pancreatic stent. Secondary outcomes included overall survival, cancer-specific survival, and changes in weight and nutritional markers following ERCP. Results: Among 562 patients, 39 (6.9%) received pancreatic stent placement. Most of the patients (90%) did not receive tumor resection because of advanced-stage disease. The stent group had a lower 1-year survival rate than the non-stent group (18% vs 30%; p = 0.047). The median survival time appeared to be shorter in the stent group (170 vs 217 days; p = 0.077). The adjusted hazard ratio of pancreatic stent placement was 1.42 (95% confidence interval, 0.75–2.67; p = 0.282). In addition, changes in weight and nutritional markers after ERCP did not differ significantly between the groups. Conclusion: Pancreatic stent placement in unresected pancreatic head cancer with obstructive jaundice does not improve survival or nutritional status.