title: Bypass surgery versus intentionally incomplete resection in palliation of pancreatic cancer: is resection the lesser evil?
abstract: OBJECTIVE
  As technical expertise increases, the indication for pancreatic resection for advanced pancreatic cancer has been expanded over the last years. Recently, several groups reported their series of unintentionally incomplete tumor resections and reported a potential survival benefit for patients after incomplete resection when compared with palliative bypass surgery. We investigated in a retrospective analysis whether even tumor resection that was intended to be incomplete might provide a better outcome than conventional palliative procedures.
  
  
  METHODS
  Twenty-two patients with a locally non-resectable or disseminated adenocarcinoma of the pancreas underwent a palliative intentionally incomplete resection. Outcome after resection was compared with that of 46 patients matched for age, sex, and histopathological tumor type who underwent a palliative bypass operation.
  
  
  RESULTS
  Overall surgical morbidity was significantly higher in the resection group (59%) compared with the bypass group (33%, p < 0.05), resulting in a higher relaparotomy rate and a significantly longer postoperative hospital stay (p < 0.001). Surgery-related mortality was significantly higher in the resection group (p < 0.05). Overall survival showed no statistically significant difference between the two groups.
  
  
  CONCLUSIONS
  Because of the higher surgery-related morbidity and mortality and lack of survival benefit in cases of advanced adenocarcinoma of the pancreas, intentionally incomplete palliative resection is not advisable.
authors.affiliation: Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Germany, Martinistraße 52, 20246, Hamburg, Germany. m.tachezy@uke.uni-hamburg.de
authors.forename: Michael
authors.initials: M
authors.lastname: Tachezy
authors.forename: Maximilian
authors.initials: M
authors.lastname: Bockhorn
authors.forename: Florian
authors.initials: F
authors.lastname: Gebauer
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.forename: Jussuf Thomas
authors.initials: JT
authors.lastname: Kaifi
authors.forename: Jakob Robert
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015904:Biliopancreatic Diversion / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome