What is the expected survival after biliary stent placement for malignant versus benign obstruction?

Survival After Biliary Stenting

For malignant biliary obstruction, median survival after stenting ranges from 3-8.5 months depending on tumor type, with cholangiocarcinoma patients surviving significantly longer (approximately 8-9 months) than pancreatic cancer patients (approximately 2-4 months). 1

Malignant Obstruction: Survival by Tumor Type

Cholangiocarcinoma

• Median survival with stenting alone: 8-8.5 months 1
• Patients with cholangiocarcinoma survive significantly longer than those with pancreatic cancer (median 286 days vs 58 days, p=0.04) 2
• When combined with chemotherapy (cisplatin plus gemcitabine), median overall survival extends to 11.7 months 1
• Endoscopic stenting is associated with longer survival than surgical bypass (19 vs 16.5 months) 1

Pancreatic Cancer

• Median survival: approximately 2-4 months (58-125 days) 2, 3
• Median overall survival of 22 weeks (approximately 5.5 months) in mixed cohorts 3
• Patients with locally advanced or metastatic disease receiving chemotherapy can achieve median survival of 11 months 4

Metastatic Disease

• Worst prognosis among all malignant causes 3
• Median survival typically less than 3 months 5

Stent-Specific Survival Data

Metal Stents

• Median overall survival after primary percutaneous metal stent placement: 165 days (approximately 5.5 months) 6
• For common bile duct obstruction: median survival 3.2 months (range 0.2-12 months) 5
• For hilar lesions: median survival 4.3 months (range 0.7-7.6 months) 5
• Metal stents are cost-effective when expected survival exceeds 4-6 months 1

Plastic Stents

• Median patency approximately 3-4 months 1, 3
• Occlusion rates: 4.2% at 3 months, 10.8% at 6 months 3
• Appropriate for patients with expected survival less than 6 months 1

Mortality Timeframes After Stenting

Critical mortality milestones for prognostication:

• 30-day mortality: 16% 2
• 90-day mortality: 41% 2
• 180-day mortality: 55% 2
• Less than half of mixed malignant cohorts survive beyond 6 months 2

Causes of Death After Stenting

Patients die from multiple causes, not just disease progression:

• Recurrent sepsis and cholangitis 1, 7
• Biliary obstruction and stent occlusion 1, 7
• Progressive malignant disease 1
• Acute cholecystitis (from covered stents) 1

Benign Obstruction

The provided evidence focuses exclusively on malignant obstruction. For benign strictures, survival is determined by the underlying disease process (e.g., chronic pancreatitis, primary sclerosing cholangitis) rather than the stenting procedure itself. Stent selection differs fundamentally: plastic stents are preferred for benign disease to allow for removal and avoid permanent foreign body complications.

Prognostic Factors

Performance status is the most important prognostic factor:

• Patients should have WHO/ECOG performance status 0-1 after biliary drainage optimization 1
• Patients who are relatively fit and not rapidly deteriorating should receive early treatment 1
• Karnofsky status ≥50 generally indicates suitability for oncological therapy 1

Quality of Life Considerations

• 90% of patients achieve 100% catheter-free survival after primary percutaneous stent placement 6
• 94% of survival days are catheter-free with modern stenting techniques 6
• 97% of patients can have transhepatic catheters removed after primary stent placement, with 73% removed within 24 hours 6
• Even achieving stable disease correlates with improved length and quality of life 1