Surgical and endoscopic palliation for pancreatic cancer

R. H.I. Andtbacka, D. B. Evans, P. W.T. Pisters

Research output: Contribution to journalReview articlepeer-review

26 Scopus 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 billary 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.

Original languageEnglish (US)
Pages (from-to)123-136
Number of pages14
JournalMinerva chirurgica
Volume59
Issue number2
StatePublished - Apr 2004

Keywords

  • Bypass surgery
  • Duodenal obstruction, pain
  • Endoscopy, Choledochojejunostomy
  • Obstructive jaundice
  • Palliative treatment
  • Pancreatic neoplasms, therapy

ASJC Scopus subject areas

  • Surgery

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