title: Palliative surgical treatment of sixty-eight patients with carcinoma of the head of the pancreas.
abstract: A retrospective study is presented of 68 patients who underwent biliary enteric bypass procedures for carcinoma of the head of the pancreas between the years of 1960 through 1975. Forty patients underwent some form of biliary enteric bypass only. Twenty-six patients were treated with concomitant gastrojejunostomy, and only two patients in this group underwent vagotomy. Two patients underwent gastrojejunostomy for obstruction at the gastric outlet without jaundice. Five operative deaths occurred among the 40 patients who underwent solely some form of biliary enteric bypass procedure, and three deaths occurred among the 26 patients who underwent concomitant gastrojejunostomy. The over-all operative mortality for biliary enteric bypass procedures was eight deaths among 68 patients. Obstruction of the duodenum developed in seven patients after undergoing a biliary enteric bypass operation. The mean postoperative interval for the development of complications was 5.57 months. All but one patient underwent a second operation, with no operative deaths. Among the 26 patients treated with concomitant gastrojejunostomy, obstruction developed in two patients because of anastomotic failure; there was massive upper gastrointestinal tract bleeding from a marginal ulcer in four patients, and one patient had a perforated marginal ulcer. The mean survival time after biliary enteric bypass was 6.69 months and after combined biliary enteric bypass and gastrojejunostomy, 9.90 months. The over-all mean survival time was 8.00 months.
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D004380:Duodenal Obstruction / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007583:Jejunum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery