Increased rates of duodenal obstruction in pancreatic cancer patients receiving modern medical management.
BACKGROUND
Duodenal obstruction from pancreatic cancer historically occurs in 2-25 % of patients without surgery, but with new advances in chemotherapy and radiation therapy, the life expectancy of pancreatic cancer has increased.


OBJECTIVE
The aim of the study was to determine the rate of development of duodenal obstruction requiring intervention in patients with pancreatic head adenocarcinoma who do not undergo surgical resection, but receive modern chemoradiation.


METHODS
It is a retrospective single center study. Inclusion criteria were patients with pancreatic cancer who underwent ERCP with metal biliary stent and then chemoradiation who subsequently developed symptomatic duodenal obstruction and underwent either metal duodenal stent placement or surgical duodenal bypass.


RESULTS
Twenty-four of 63 patients (38 %, 95 % CI 26-50 %) with unresectable pancreatic cancer and biliary stents who received chemotherapy and/or radiation therapy developed duodenal obstruction. The average length of time from diagnosis of pancreatic adenocarcinoma to development of outlet obstruction was 11.4 ± 4.9 months (range 1.5-40 months). Average length of time from development of duodenal obstruction to death was 4.8 ± 2.1 months (range 0.5-60 months). Average survival time from diagnosis to death was 16.6 ± 5.6 months (range 4.5-58 months).


CONCLUSIONS
Thirty-eight percent of patients with unresectable pancreatic head adenocarcinoma and metal biliary stents who receive chemotherapy and/or radiation therapy eventually develop symptomatic duodenal obstruction requiring duodenal stent or surgical bypass. This rate of duodenal obstruction is nearly twice that of previous reports using older oncologic therapy and will likely increase as patients survive longer with advances in medical therapy for pancreatic cancer.
Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA, shahar3682@gmail.com.
Ashish
A
Shah
Abbas
A
Fehmi
Thomas J
TJ
Savides
D000368:Aged; D059248:Chemoradiotherapy; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004378:Duodenal Diseases / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate; D013997:Time Factors