Stent choice for preoperative biliary drainage in pancreatic cancer does not affect long-term survival.

• Among 6,429 patients, overall and recurrence-free survival were similar for plastic (PS) and metal stents (MS) after pancreaticoduodenectomy, even in those receiving neoadjuvant therapy.
• No significant difference in postoperative complications between PS and MS.

Choose stents based on drainage duration and treatment approach, not survival expectations.

• Secondary analysis showed no survival differences between endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD).