Surgeons need to know that plastic and metal stents show similar long-term outcomes in patients with pancreatic ductal adenocarcinoma undergoing preoperative biliary drainage.

• Among over 6,500 patients, overall survival and recurrence-free survival were not significantly different between plastic and metal stents.
• Postoperative complications also showed no significant differences between stent types.

Stent selection should be based on drainage duration and treatment strategies rather than presumed prognostic outcomes.

• No survival differences were found when comparing endoscopic and percutaneous drainage methods.