Impact of Stent Type on Surgical Outcomes in Pancreatic Cancer Patients Undergoing Preoperative Biliary Drainage

BACKGROUND AND AIM: Metal (MS) or plastic stents (PS) are placed for preoperative biliary drainage (PBD) in patients with pancreatic ductal adenocarcinoma (PDAC) undergoing neoadjuvant chemotherapy (NAC) or chemoradiotherapy (NACRT). This multicentre retrospective study compared the safety and efficacy of PBD using MS and PS, including surgery-related adverse events (AEs) and other clinical outcomes. METHODS: This study enrolled patients with resectable or borderline resectable PDAC requiring NAC or NACRT who underwent PBD with MS or PS at 17 tertiary care hospitals in Japan between January 2016 and December 2021. Clinical outcomes were retrospectively analysed. RESULTS: Of the 249 patients who underwent pancreatectomy, 121 underwent PBD with MS and 128 with PS. Because there were significant differences in baseline characteristics between these groups, propensity score matching was performed, resulting in 66 matched pairs. The RBO rate was significantly lower (15.2% vs. 56.1%, p < 0.001); the time to surgery (p = 0.027) and postoperative hospital stay (p = 0.036) were significantly shorter in the MS group. The incidence of postoperative AEs was significantly lower in the MS group (18.2% vs. 34.9%, p = 0.030) than in the PS group. Univariate and multivariate analyses identified the placement of an MS for PBD as an independent protective factor for postoperative AEs (odds rates: 0.35, p = 0.017). CONCLUSION: In patients with PDAC undergoing NAC or NACRT, MS placement for PBD was associated with lower rates of postoperative AEs and RBO than PS placement. MS is a more suitable option than PS for PBD.