Background: Pancreatic cancer has historically been associated with particularly poor survival rates. The placement of duodenal stents has been utilized to palliatively treat patients with malignant gastric outlet obstruction. Furthermore, duodenal stents are used to treat patients who are considered high-risk surgical candidates. We aimed to study the survival and clinical outcomes after endoscopic duodenal stent placement for patients with pancreatic cancer in comparison to patients who do not undergo stent placement. Methods: The NIS database was queried for the years 2015–2019. Adult patients (>age 18) with a diagnosis of pancreatic cancer with duodenal stent placement versus pancreatic cancer without duodenal stent placement were identified using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes were hospital length of stay (LOS) and total hospital charges (TOTHC). Complications for each group were analyzed. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Statistical analysis was performed using STATA. Results: We identified 91,920 patients who had pancreatic cancer. Out of that, we found 1,100 patients who underwent duodenal stent placement. After propensity score matching, patients undergoing duodenal stent had decreased mortality (OR 0.50, p< 0.0001, CI: 0.37–0.68), but had increased LOS (3.09 days, p< 0.0001, CI: 2.72–3.58) and increased TOTCH ($33,993, p< 0.0001, CI: $28,687-$39,299) compared to patients without duodenal stent placement. Multivariate regression revealed the impact of complications on the primary and secondary outcomes (listed in Table 1 and Table 2). Discussion/Conclusion: Patients with pancreatic cancer undergoing duodenal stent placement had lower mortality in comparison to patients not getting treatment with duodenal stents for pancreatic cancer. Complications of malnutrition and sepsis increased mortality, LOS, and total hospital charges. This is an important study that demonstrates that the placement of duodenal stents does not increase mortality in this high-risk population despite increased LOS and TOTCH.
Primary outcomes for patients with pancreatic cancer undergoing duodenal stent vs pancreatic cancer only.
Table 2. Secondary outcomes for patients with pancreatic cancer undergoing duodenal stent vs pancreatic cancer only.
