title: Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal.
abstract: This study aimed to reappraise short-term and long-term results of palliative biliary and gastric bypass surgery in patients with unresectable pancreatic head carcinoma found at explorative laparotomy. We retrospectively analyzed 83 consecutive patients whose pancreatic head carcinoma appeared unresectable at laparotomy (vascular involvement [57%], liver metastases [24%], distant metastatic lymph nodes [11%], peritoneal implants [8%]) and who underwent palliative surgical concomitant biliary and gastric bypass. Postoperative mortality and morbidity rates were 4.8% and 26.5%, respectively. Postoperative-delayed gastric emptying occurred in 9 patients (10%). Antecolic (46%) and retrocolic (54%) gastrojejunostomies did not differ for the duration of nasogastric suction, the delay of oral intake, and the incidence of delayed gastric emptying. Mean hospital stay was 16 +/- 8 days. Median survival was 9 months (range 1-44). Late cholangitis occurred in 2 patients (2.4%) treated medically. One recurrent jaundice required transhepatic stenting 9 months from surgery. Four late gastric outlet obstructions occurred (4.8%) with a mean delay of 8 months from surgery. These data demonstrate that, in patients with unresectable pancreatic head carcinoma at laparotomy, palliative concomitant biliary and gastric bypass in a single procedure is safe and long-term efficient. This strategy remains to be compared to endoscopic palliation in this setting.
authors.affiliation: Department of Digestive Surgery, Saint Antoine University-Hospital, 184 Rue du Faubourg Saint Antoine, 75012 Paris, France.
authors.forename: Mickael
authors.initials: M
authors.lastname: Lesurtel
authors.forename: Nidal
authors.initials: N
authors.lastname: Dehni
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tiret
authors.forename: Rolland
authors.initials: R
authors.lastname: Parc
authors.forename: François
authors.initials: F
authors.lastname: Paye
mesh_terms: D014670:Ampulla of Vater / Q000601:surgery*; D015904:Biliopancreatic Diversion / Q000379:methods; D002277:Carcinoma / Q000556:secondary / Q000601:surgery; D002761:Cholangitis / Q000209:etiology; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004750:Enteral Nutrition; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods; D005746:Gastric Emptying / Q000502:physiology; D017219:Gastric Outlet Obstruction / Q000209:etiology; D006801:Humans; D007441:Intubation, Gastrointestinal; D007902:Length of Stay; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000556:secondary; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome