A continuing role for surgical bypass in the palliative treatment of pancreatic carcinoma.
BACKGROUND
The use of palliative surgery for irresectable pancreatic cancer has been challenged by the advent of non-operative stenting, but it may still be appropriate for selected patients.


METHODS
Single-loop biliary and gastric bypass was carried out in 56 patients (mean age 60 years) with carcinomas of the pancreatic head that were irresectable because of vascular invasion or distant spread. In 42 patients without a preoperative tissue diagnosis, ductal carcinoma was confirmed by biopsy of the primary (n = 20) or secondary (n = 22) tumour. Preoperative biliary decompression in 31 patients led to positive bile cultures in 22 of 24 patients sampled.


RESULTS
There were no deaths in hospital or within 30 days. Complications in 20 patients (35%) included three biliary leaks, two of which required temporary percutaneous stents. The median postoperative hospital stay was 14 days. No re-operations were required before death, though 2 patients required percutaneous stenting of the biliary anastomosis for recurrent jaundice, 1 of whom had a radiation-induced stricture. The median survival was 6 (range 2-21) months.


CONCLUSIONS
Combined biliary and gastric bypass can be carried out with reasonable safety and remains a useful option for patients with potentially resectable tumours and an anticipated life expectancy of at least 6 months.
Isla
A M
AM
Department of Surgery, Royal Postgraduate Medical School of Hammersmith Hospital, London, UK. aisla@rpms.ac.uk
Worthington
T
T
Kakkar
A K
AK
Williamson
R C
RC
D000230:Adenocarcinoma / Q000601:surgery*; D015904:Biliopancreatic Diversion / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010166:Palliative Care; D010179:Pancreas / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011183:Postoperative Complications; D016019:Survival Analysis