Background and Aim: PCMS (Wallstent, Boston Scientific) have been extensively used for palliation of malignant distal biliary strictures. Many centers have been using them as a bridge to surgery (BTS) regardless of resectability with or without eventual neoadjuvant therapy. We analyzed the outcome of all patients receiving PCMS who were subsequently referred for surgery.Methods: Our prospectively established pancreatico-biliary database was retrospectively analyzed, to retrieve all patients undergoing PCMS placement for malignant biliary stricture and then undergoing surgery. Cancer type and staging, adverse events related to stent placement or surgery, type of surgery performed, time between stenting and surgery, length of hospitalization post op and follow-up post surgery were recordedResults: 27 patients (21 men, median age of 66 years, range 39-82) received PCMS (Table 1). Indications for placement included biliary stricture related to pancreatic cancer (n=23) or other cancers (n=4). Median time between stenting and surgery was 32 days (range: 6-569). Median hospitalization following surgery was 7 days (0-40). All patients underwent exploratory laparoscopy, followed in 8 (30%) by a Whipple procedure with uneventful removal of the PCMS. 19 patients (70%) were found to be unresectable on laparoscopy or laparotomy with 8 (30%) patients undergoing peritoneal or liver metastasis biopsy. PCMS were left in place in those 19 patients. Complication related to PCMS included migration (n=5, 19%), tissue overgrowth (n=2, 7%), and impaction (n=1, 4%), all of them managed by endoscopic removal and replacement with PCMS, with only one of them subsequently undergoing a Whipple, the others being unresectable. Median follow-up post surgery was 210 days (range: 9-1642). Conclusion:PCMS are an appropriate BTS option. For resectable patients, PCMS results in biliary drainage and allows for neoadjuvant treatment without precluding subsequent curative resection (Whipple). For unresectable patients, long term biliary drainage is provided by PCMS.
Table 1

N	27
Pancreatic adenocarcinomaLymphomaDuodenal AdenocarcinomaMetastatic Breast Cancer	23 (85%)2 (7%)1 (4%)1 (4%)
Stage IStage IIStage IIIStage IV	3 (11%)8 (29%)12(45%)4 (15%)
Preop Chemoradiation	2 (7%)
Time from Stent to Surgery (days)	32 (6-569)
LaparoscopyWhippleBiopsy	27 (100%)8 (30%)8 (30%)
Total Curative Resection(Whipple)	8 (30%)
Duration of Hospitalization (days)	7 (0-40)
STENT COMPLICATIONSMigrationTissue overgrowthImpaction	5 (19%2 (7%)1 (4%)

Value listed as number (%) or median (range)* Time after stent removal