Faculty Collaboration Database

Surgical and endoscopic palliation for pancreatic cancer. Minerva Chir 2004 Apr;59(2):123-36

Date

07/09/2004

Pubmed ID

15238887

Scopus ID

2-s2.0-4043073368 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

Patients with pancreatic cancer often present with locally advanced or metastatic disease and are deemed not to be candidates for a curative resection. Palliation in these patients focuses on relief of biliary obstruction, gastroduodenal obstruction and pain. Palliative treatment modalities include both surgical and nonsurgical approaches. Biliary obstruction is often initially treated with endoscopic biliary stenting. Two major types of biliary stents are used, plastic and metallic stents. Both of these provide similar initial relief of biliary obstruction, however, plastic stents have a greater propensity for occlusion and should primarily be used in patients with anticipated short survival duration. Metallic stents have a greater initial cost, but provide an overall cost-saving in patients with expected survival duration of over 6 months. Surgical palliation for biliary obstruction should be primarily considered in patients who fail endoscopic biliary decompression or who develop clinical evidence of gastroduodenal obstruction. In these patients, surgical palliation should consist of biliary decompression with a choledochojejunostomy when ever feasible, a gastroduodenal bypass and a chemical splanchnicectomy for pain relief. An initial prophylactic gastroenterostomy at the time of endoscopic biliary decompression is rarely indicated. The role of palliative pancreaticoduodenectomy remains controversial and to date there are no prospective randomized data to support its role in palliation of locally advanced pancreatic cancer. This review examines the available data from prospective trials for surgical and nonsurgical palliation of locally advanced and metastatic pancreatic cancer.

Author List

Andtbacka RH, Evans DB, Pisters PW

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Choledochostomy
Cholestasis, Extrahepatic
Clinical Trials as Topic
Decompression, Surgical
Digestive System Surgical Procedures
Endoscopy, Digestive System
Gastric Outlet Obstruction
Gastroenterostomy
Humans
Palliative Care
Pancreatic Neoplasms
Prospective Studies
Splanchnic Nerves
Stents