[Palliative procedures in the treatment of non-resectable pancreatic tumors. Retrospective study of 294 cases and review of the literature].
At least two thirds of patients with pancreatic cancer are still unsuitable for resection, because of the extent of their disease or because of their high-risk conditions. In these cases, a palliative treatment is indicated to maximize the quality of life, in spite of the poor prognosis. During the years 1959-95, two-hundred-ninety-four patients, affected with pancreatic neoplasm, were observed. Resectability rate was 18%. One-hundred patients underwent surgical palliation (34%): 58 biliary-bypasses, 15 gastroenterostomies and 27 double-bypasses. Sixty-nine explorative laparotomies were performed (23.4%), of which thirty-six were carried out during the years 1959-70. Sixty-three patients did not undergo surgical treatment (21.6%), of which twenty-two underwent percutaneous biliary drainage, during the years 1981-95. Overall morbidity rate was 13% with decrease during the years of major postoperative complications. During the years 1959-70 operative mortality rate after surgical bypass was 13.6%, during 1971-80 was 10.5% and during 1981-95 decreased to 8.1%. Major percentages were reported after explorative laparotomies. During the years 1959-70 and 1971-80, operative mortality rate was 16.6%, compared with 9.5% during the years 1981-95. Patients with stage II tumours survived palliative surgery for about 12.8 months, compared with those with stage III and IV tumours, who survived for about 10.6 and 5 months, respectively. Patients who did not undergo surgical treatment survived 8.3, 4 and 1.3 months, respectively in II-III and IV stages. In this paper the authors examine advantages and disadvantages of palliative procedures, on the bases of their aims: relief of obstructive jaundice, duodenal obstruction and pain.
II Clinica Chirurgica, Università di Roma La Sapienza.
D
D
Proposito
R
R
Santoro
B
B
Mancini
S
S
Gallina
M
M
Carboni
D000368:Aged; D002779:Cholestasis / Q000209:etiology / Q000628:therapy; D004380:Duodenal Obstruction / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate