Palliation of malignant jaundice.
The great majority--perhaps 90%--of patients with malignant jaundice can only be treated by palliative means. The best method of palliation is yet to be defined. Some groups advocate routine surgical bypass, while others hold that all cases should be managed by the insertion of stents, either endoscopically or percutaneously. Recovery from surgery consumes a significant portion of residual lifespan, while stents produce long-term morbidity from stent blockage and cholangitis. The present study used a convenient and simple method to quantify the quality of life that follows surgical bypass and stent insertion. Six patients were followed for at least 6 months after open bypass, and nine after stent insertion. Four patients in each group were still alive at 12 months. The study suggests that there is no significant difference in the quality of life obtained by either method at 6 months, but that there is a clear-cut advantage in having surgical bypass by 12 months. The study points to the need to evolve better stents, to improve stent management and to define criteria which will identify patients who are likely to survive more than 6 months.
Little
J M
JM
Department of Surgery, Westmead Hospital, New South Wales, Australia.
Wong
K P
KP
D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D002768:Choledochostomy / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005763:Gastroenterostomy; D006801:Humans; D007565:Jaundice / Q000523:psychology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011788:Quality of Life; D011859:Radiography; D012008:Recurrence; D015607:Stents / Q000592:standards*; D013997:Time Factors