title: Cost-effective analysis of surgical palliation versus endoscopic stenting in the management of unresectable pancreatic cancer.
abstract: BACKGROUND
  Ductal carcinoma of the pancreas is unresectable for cure in the majority of patients. We reviewed our results and cost effectiveness of surgical and endoscopic biliary bypass for unresectable pancreatic cancer to evaluate the comparable outcomes.
  
  
  METHODS
  Between 1990 and 1992, 136 patients were managed operatively or endoscopically for pancreatic carcinoma. Excluding potentially curative resections and patients without follow-up, 34 patients endoscopically stented and 32 patients surgically bypassed were evaluated.
  
  
  RESULTS
  Mean patient age was older (72.1 vs. 69.3 years) but average performance status was comparable (0.8 vs. 0.9 Eastern Cooperative Oncology Group grading) in the medical treatment group. The initial hospital stay was significantly longer for surgical patients (mean 14 vs. 7 days, p < 0.001), with higher average charges ($18,325 vs. $9,663). Twelve stented patients required rehospitalization (average charge of $4,029), and eight surgical patients were readmitted (average charge of $6,776). An average of 1.7 stent changes (average charge $1,190) were required. Mean survival was longer for the stented group (9.7 vs. 7.3 months, p = 0.13).
  
  
  CONCLUSIONS
  Endoscopic stenting for unresectable pancreatic cancer provides equivalent duration of survival at reduced cost and shorter hospital stay, although subsequent stent changes are necessary. When curative resection is not possible, endoscopic biliary drainage should be considered a good first choice for palliative management.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: G V
authors.initials: GV
authors.lastname: Raikar
authors.forename: M M
authors.initials: MM
authors.lastname: Melin
authors.forename: A
authors.initials: A
authors.lastname: Ress
authors.forename: S Z
authors.initials: SZ
authors.lastname: Lettieri
authors.forename: J J
authors.initials: JJ
authors.lastname: Poterucha
authors.forename: D M
authors.initials: DM
authors.lastname: Nagorney
authors.forename: J H
authors.initials: JH
authors.lastname: Donohue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000191:economics*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D003362:Cost-Benefit Analysis; D004724:Endoscopy / Q000191:economics*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000191:economics*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality; D012189:Retrospective Studies; D015607:Stents; D015996:Survival Rate