TY - JOUR
T1 - Efficacy and safety of chemotherapy after endoscopic double stenting for malignant duodenal and biliary obstructions in patients with advanced pancreatic cancer
T2 - A single-institution retrospective analysis
AU - Matsumoto, Kazuyuki
AU - Kato, Hironari
AU - Horiguchi, Shigeru
AU - Tsutsumi, Koichiro
AU - Saragai, Yosuke
AU - Takada, Saimon
AU - Mizukawa, Sho
AU - Muro, Shinichiro
AU - Uchida, Daisuke
AU - Tomoda, Takeshi
AU - Okada, Hiroyuki
N1 - Funding Information:
This retrospective study was approved by the Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Okayama University Hospital, Ethics Committee review board for human research (approval no.1601–503). This study obtained informed consent to participate by disclose information about this study on our institution HP (opt -out methods). All of the participants provided written informed consent of treatment (endoscopic procedure, chemotherapy).
PY - 2018/10/26
Y1 - 2018/10/26
N2 - Background: Advanced pancreatic cancer is accompanied not only by bile duct obstruction, but also occasionally by duodenal obstruction. With new advances in chemotherapy and improvement in the management of stent dysfunction, the life expectancy of patients with pancreatic cancer has increased. This study aimed to evaluate the efficacy and safety of chemotherapy for advanced pancreatic cancer, as well as to analyze the prognostic factors, following endoscopic double stenting. Methods: This retrospective study was conducted from January 1, 2007 to October 31, 2015 at an academic center. Fifty consecutive patients with pancreatic cancer who had undergone endoscopic double stenting, comprising duodenal and biliary stenting, were analyzed. We reviewed the patients records and analyzed the data of stent dysfunction rates after double stenting, reintervention for stent dysfunction, chemotherapy after double stenting, adverse events associated with chemotherapy after double stenting, survival times following double stenting, and overall survival times. The hospital's institutional review board for human research approved this study. Results: The overall survival time and the survival time following double stenting were 10.9 months (IQR 6.0-18.4 months) and 2.4 months (IQR 1.4-5.2 months), respectively. After double stenting, duodenal stent dysfunction occurred in 6 patients (12%), and biliary stent dysfunction occurred in 12 patients (24%), respectively. All patients who experienced stent dysfunction underwent endoscopic reintervention, and all of the procedures were successful. Twenty-one (42%) patients were treated with chemotherapy post double stenting; 9 patients received chemotherapy as a first-line treatment, 9 as a second-line treatment, and 3 as a third-line treatment. During chemotherapy, 8 (38%) patients had grade 3-4 adverse events, which were manageable. Chemotherapy post double stenting (OR, 0.19; 95% CI, 0.059-0.60; P =.0051), reintervention for biliary stent dysfunction (OR, 0.21; 95% CI, 0.081-0.50; P =.0002), and performance status (< 2) (OR, 0.28; 95% CI, 0.098-0.71; P =.0064) were significant prognostic factors after double stenting. Conclusions: Systemic chemotherapy was manageable, even in patients with double stenting. Chemotherapy after double stenting and appropriate reintervention for stent obstructions potentially prolonged the survival of patients with advance pancreatic cancer.
AB - Background: Advanced pancreatic cancer is accompanied not only by bile duct obstruction, but also occasionally by duodenal obstruction. With new advances in chemotherapy and improvement in the management of stent dysfunction, the life expectancy of patients with pancreatic cancer has increased. This study aimed to evaluate the efficacy and safety of chemotherapy for advanced pancreatic cancer, as well as to analyze the prognostic factors, following endoscopic double stenting. Methods: This retrospective study was conducted from January 1, 2007 to October 31, 2015 at an academic center. Fifty consecutive patients with pancreatic cancer who had undergone endoscopic double stenting, comprising duodenal and biliary stenting, were analyzed. We reviewed the patients records and analyzed the data of stent dysfunction rates after double stenting, reintervention for stent dysfunction, chemotherapy after double stenting, adverse events associated with chemotherapy after double stenting, survival times following double stenting, and overall survival times. The hospital's institutional review board for human research approved this study. Results: The overall survival time and the survival time following double stenting were 10.9 months (IQR 6.0-18.4 months) and 2.4 months (IQR 1.4-5.2 months), respectively. After double stenting, duodenal stent dysfunction occurred in 6 patients (12%), and biliary stent dysfunction occurred in 12 patients (24%), respectively. All patients who experienced stent dysfunction underwent endoscopic reintervention, and all of the procedures were successful. Twenty-one (42%) patients were treated with chemotherapy post double stenting; 9 patients received chemotherapy as a first-line treatment, 9 as a second-line treatment, and 3 as a third-line treatment. During chemotherapy, 8 (38%) patients had grade 3-4 adverse events, which were manageable. Chemotherapy post double stenting (OR, 0.19; 95% CI, 0.059-0.60; P =.0051), reintervention for biliary stent dysfunction (OR, 0.21; 95% CI, 0.081-0.50; P =.0002), and performance status (< 2) (OR, 0.28; 95% CI, 0.098-0.71; P =.0064) were significant prognostic factors after double stenting. Conclusions: Systemic chemotherapy was manageable, even in patients with double stenting. Chemotherapy after double stenting and appropriate reintervention for stent obstructions potentially prolonged the survival of patients with advance pancreatic cancer.
KW - Chemotherapy
KW - Double stenting
KW - Pancreatic cancer
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U2 - 10.1186/s12876-018-0886-8
DO - 10.1186/s12876-018-0886-8
M3 - Article
C2 - 30367599
AN - SCOPUS:85055612416
VL - 18
JO - BMC Gastroenterology
JF - BMC Gastroenterology
SN - 1471-230X
IS - 1
M1 - 157
ER -