Stent Patency and Survival after PTBD and Biliary Stenting for Pancreatic Cancer: A 5-Year Retrospective Cohort Study.

BACKGROUND

Obstructive jaundice commonly complicates pancreatic cancer and often requires biliary decompression. Percutaneous transhepatic biliary drainage (PTBD) followed by stent placement is used for palliation, but long-term stent patency and the relationship between patency and overall survival (OS) remain incompletely characterized.

METHODS

We conducted a retrospective cohort study of 60 consecutive patients who underwent sequential PTBD and biliary stent placement at the Affiliated Hospital of Jiangnan University (Wuxi, China) between January 2020 and December 2024. Primary endpoint was stent patency (time from stent insertion to radiologically confirmed occlusion or repeat intervention). Secondary endpoint was OS measured from stent insertion. Patient characteristics, stent type (covered vs uncovered), tumor location, stage, and receipt of systemic chemotherapy were extracted from electronic medical records. Kaplan-Meier analysis and Cox proportional hazards models (adjusted for age, sex, cancer stage, tumor location, baseline bilirubin and chemotherapy) were used. Proportional hazards assumption was tested using Schoenfeld residuals.

RESULTS

Median stent patency was 12.0 months (IQR 8.0-15.0) and median OS was 9.5 months (IQR 6.0-13.0). Covered stents were associated with longer patency (median 13.0 vs 11.0 months; log-rank P=0.018). In multivariable Cox regression, Stage IV disease (adjusted HR 2.50; 95% CI 1.68-3.86; P<0.001) and age (per year, adjusted HR 1.05; 95% CI 1.02-1.09; P=0.002) were independent predictors of mortality; covered stent use was associated with lower mortality (adjusted HR 0.78; 95% CI 0.61-0.99; P=0.043). Schoenfeld tests showed no violation of the proportional hazards assumption (global P=0.18). Stent-related complications occurred in 16.7% of patients (migration 5.0%, infection 3.3%, biliary leak 1.7%, recurrent jaundice 6.7%).

CONCLUSION

Sequential PTBD and biliary stenting provides effective biliary decompression with a median stent patency of 12 months but only limited impact on OS, which is dominated by disease stage. Covered stents improved patency and were associated with a modest survival advantage after adjustment. Prospective, multicenter studies are required to confirm these findings and to explore integration with systemic therapies.