title: Bypass surgery versus palliative pancreaticoduodenectomy in patients with advanced ductal adenocarcinoma of the pancreatic head, with an emphasis on quality of life analyses.
abstract: BACKGROUND
  In some centers, palliative resection (PR; partial pancreaticoduodenectomy) is, in selected cases, promoted in preference to double loop bypass (DLB) surgery for advanced pancreatic cancer. This prospective study compares PR with DLB, placing particular focus on patients' quality of life (QoL).
  
  
  METHODS
  From 01/1993 to 09/2004, 167 patients were analyzed in a prospective single center study of palliative surgical treatment of advanced ductal adenocarcinoma of the pancreatic head. Thirty-eight underwent PR and 129 underwent palliative DLB. Patients undergoing DLB were divided into: (1) locally advanced disease (LAD-subgroup; n = 61; 47%) and (2) metastasized disease (MD-subgroup; n = 68; 53%). QoL was assessed using the EORTC QLQ-C30 questionnaire supplemented by a pancreatic cancer specific module. QoL data were collected pre-operatively and for up to 12 months after surgery.
  
  
  RESULTS
  Median survival was 7.0 months (95% CI 4.09; 9.91) in PR patients and 6.0 months (95% CI 5.39; 6.61) in patients who received DLB. Mortality and morbidity were, respectively, 7.8 and 58% for PR, and 2.6 and 42% for DLB. QoL decreased more after PR than after DLB. The DLB-group recovered quicker, reaching pre-operative QoL levels after 3 months, and were less impaired when discharged. The LAD-subgroup and the MD-subgroup presented with equal levels of QoL.
  
  
  CONCLUSIONS
  QoL analysis revealed favorable QoL data after DLB. Additionally, the survival rates of the two groups did not differ significantly, but morbidity and mortality rates in the PR group were elevated. Therefore, the use of PR for advanced pancreatic cancer needs to be carefully evaluated.
authors.affiliation: Clinic for General and Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 7, 24105, Kiel, Germany. schniewind@surgery.uni-kiel.de
authors.forename: B
authors.initials: B
authors.lastname: Schniewind
authors.forename: B
authors.initials: B
authors.lastname: Bestmann
authors.forename: R
authors.initials: R
authors.lastname: Kurdow
authors.forename: J
authors.initials: J
authors.lastname: Tepel
authors.forename: D
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: F
authors.initials: F
authors.lastname: Faendrich
authors.forename: B
authors.initials: B
authors.lastname: Kremer
authors.forename: T
authors.initials: T
authors.lastname: Kuechler
mesh_terms: D000368:Aged; D015904:Biliopancreatic Diversion / Q000379:methods*; D021441:Carcinoma, Pancreatic Ductal / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate