title: Hepaticocholecystojejunostomy as effective palliative biliary bypass for unresectable pancreatic cancer.
abstract: OBJECTIVE
  The majority of patients with pancreatic cancer present with far advanced disease and jaundice. With the advancement of endoscopic interventional techniques, the role of surgical bypass has declined. However, surgical bypass is still considered to be appropriate in patients who are able to tolerate surgery. We performed hepaticocholecystojejunostomy consecutively as a palliative surgical biliary bypass for the purpose of long-term palliation. The aim of this study was to analyze the results of our palliative surgical biliary bypass, hepaticocholecystojejunostomy.
  
  
  METHODS
  Between January 2001 through December 2009, 69 patients received palliative surgical biliary bypass (bypass group) and 33 patients received endoscopic biliary stenting (stent group) for unresectable pancreatic cancers. Mortality, morbidity and survival between the two groups were compared.
  
  
  RESULTS
  There was no in-hospital death in the bypass group, but 2 patients (6%) in the stent group died in the hospital (p = 0.04). The surgical morbidity rate was 15% in the bypass group, while 20 patients (61%) in the stent group developed complications, mainly due to stent blockage. There was no significant difference in overall survival between the two groups. Among patients who underwent systemic chemotherapy but did not present with jaundice at the time of diagnosis, those who underwent prophylactic surgical biliary bypass before chemotherapy showed better survival than those who underwent systemic chemotherapy preceding biliary bypass or biliary stenting after occurrence of jaundice (p = 0.01).
  
  
  CONCLUSIONS
  Hepaticocholecystojejunostomy resulted in negligible mortality, low morbidity and effective long-term palliation. Prophylactic surgical biliary bypass with gastrointestinal bypass might be a good treatment option for non-jaundiced patients undergoing chemotherapy for unresectable pancreatic cancer.
authors.forename: Junji
authors.initials: J
authors.lastname: Ueda
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kayashima
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Mori
authors.forename: Takao
authors.initials: T
authors.lastname: Ohtsuka
authors.forename: Shunich
authors.initials: S
authors.lastname: Takahata
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakamura
authors.forename: Masao
authors.initials: M
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D003952:Diagnostic Imaging; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery*; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome