title: [Palliative treatment of pancreatic adenocarcinoma].
abstract: Carcinoma of the pancreas is the fourth leading cause of cancer related death in Western Countries. The 5-year survival for resectable tumors is 15-25%, while patients with unresectable neoplasms survive a median of 7 months. Only 30% of carcinomas of the head of pancreas and 10% of the body and tail are resectable for cure. Therefore, palliation of symptoms, namely obstructive jaundice, duodenal obstruction and pain, involve 80-90% of cases. Jaundice is frequent in tumors of the head. Palliative biliary decompression can be achieved by non surgical methods-endoscopically placed endoprostheses or percutaneous biliary drainage- or surgically. The former are indicated in patients with metastatic disease, high operative risk and short life expectancy. Surgical palliation which includes choledocho-duodenostomy, cholecystoduodenostomy, cholecystojejunostomy, hepato or choledocho-jejunostomy offers the advantage of providing a simple procedure that can treat or prevent all of the major symptoms: jaundice, duodenal obstruction and pain. Mechanical obstruction of the duodenum occurs in about 30% of cases in association with jaundice at the time of presentation and in 13-21% of patients previously subjected to biliary bypass after 8 months. Actual obstruction can be relieved by gastro-jejunostomy. Significant controversy remains concerning the role of prophylactic gastro-jejunostomy in patients requiring biliary diversion without signs of duodenal obstruction. Pain, which sooner or later affects the majority of patients, can be relieved by splanchnicectomy, either surgically or percutaneously.
authors.affiliation: Università degli Studi di Verona, I Divisione Clinicizzata di Chirurgia Generale.
authors.forename: A
authors.initials: A
authors.lastname: Guglielmi
authors.forename: G
authors.initials: G
authors.lastname: De Manzoni
authors.forename: R
authors.initials: R
authors.lastname: Girlanda
authors.forename: M
authors.initials: M
authors.lastname: Frameglia
authors.forename: C
authors.initials: C
authors.lastname: Cordiano
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D004380:Duodenal Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D007565:Jaundice / Q000209:etiology / Q000601:surgery*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*; D013153:Splanchnic Nerves / Q000601:surgery
vernacular_title: Il trattamento palliativo dell'adenocarcinoma pancreatico.