Are there indications for palliative resection in pancreatic cancer?
Controversy exists about the indication for a palliative pancreatoduodenectomy. A palliative resection for patients with a pancreatic carcinoma can be performed safely nowadays with low mortality and acceptable morbidity in centers with experience. The early results in terms of mortality and morbidity are not different from resections with curative intent or even after bypass surgery. The procedure seems effective for controlling symptoms of the disease, and the quality of life after a palliative resection is acceptable and not worse than after bypass surgery. It is, however, still doubtful whether the incidence of symptom recurrence, such as jaundice, obstruction, and pain, is lower after resection than after bypass surgery. The longer survival after palliative resection could also be due to patient selection and postoperative treatment. There are no randomized trials to prove the superiority of palliative resection over bypass surgery. The safety of pancreatic resection for cancer has already changed the policy in centers with experience, and surgeons are more willing to perform a resection because the results are better or at least the same as after bypass surgery. There are, however, no results to confirm that a palliative resection should be performed routinely or to justify resection as a debulking procedure.
Gouma
D J
DJ
Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Nieveen van Dijkum
E J
EJ
van Geenen
R C
RC
van Gulik
T M
TM
Obertop
H
H
D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000628:therapy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000628:therapy; D007565:Jaundice / Q000209:etiology / Q000628:therapy; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011788:Quality of Life; D016019:Survival Analysis