title: Palliative partial pancreaticoduodenectomy impairs quality of life compared to bypass surgery in patients with advanced adenocarcinoma of the pancreatic head.
abstract: BACKGROUND
  Some surgical centres consider palliative resection (PR) to be superior to double loop bypass (DLB) as treatment for advanced carcinoma of the pancreatic head. We performed a retrospective study with prospectively collected data at a single centre to compare PR and DLB in regard to quality of life (QoL).
  
  
  METHODS
  From January 1996 to September 2008, 196 patients were given palliative surgery for advanced pancreatic cancer at the University Hospital of Kiel. Forty-two patients underwent PR and 154 underwent DLB. These groups were compared with regard to survival, post-operative morbidity, and QoL. The EORTC QLQ-C30 was used to assess QoL before surgery, at discharge, three months after surgery, and six months after surgery.
  
  
  RESULTS
  The median survival time after PR was 7.5 months (95% CI: 4.95-10.05) and after DLB was 6 months (95% CI: 4.98-7.02; log rank test: p = 0.066). There were no significant differences in mortality and morbidity rates (7.1% and 45.2% for PR; 3.9% and 38.3% for DLB, respectively). Assessment of QoL indicated that patients who underwent PR had more impairment of some functional metrics and increased symptoms compared to those who underwent DLB.
  
  
  CONCLUSIONS
  There was no significant difference in survival or morbidity after PR and DLB, but patients who underwent DLB had better QoL than patients who underwent PR. Therefore, clinicians may want to reconsider the use of PR for patients with advanced pancreatic cancer.
authors.affiliation: Clinic for General and Thoracic Surgery, University Clinic of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Haus 18, 24105 Kiel, Germany. jessica.walter@uksh-kiel.de
authors.forename: J
authors.initials: J
authors.lastname: Walter
authors.forename: A
authors.initials: A
authors.lastname: Nier
authors.forename: T
authors.initials: T
authors.lastname: Rose
authors.forename: J H
authors.initials: JH
authors.lastname: Egberts
authors.forename: C
authors.initials: C
authors.lastname: Schafmayer
authors.forename: T
authors.initials: T
authors.lastname: Kuechler
authors.forename: D C
authors.initials: DC
authors.lastname: Broering
authors.forename: B
authors.initials: B
authors.lastname: Schniewind
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015904:Biliopancreatic Diversion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011788:Quality of Life