title: Laparoscopic hepaticojejunostomy and gastrojejunostomy for palliative treatment of pancreatic head cancer in 48 patients.
abstract: BACKGROUND
  Approximately 80% of patients with pancreatic cancer are not candidates for curative resection at the time of diagnosis. The objective of this study is to show that although endoscopic treatment is the standard palliation, surgical laparoscopic treatment is both feasible and effective for these patients.
  
  
  METHODS
  Preoperative resectability was evaluated by dynamic contrast-enhanced computed tomography scans. Endoscopic palliation was the first choice for patients with metastatic disease and for patients with locally advanced pancreatic cancer with bad performance status. Laparoscopic surgical palliation was indicated for patients with jaundice and locally advanced pancreatic cancer (elective palliation) and for patients with jaundice with metastatic disease and failure in the endoscopic/percutaneous treatment (necessary palliation). Elective palliation consisted of Roux-en-Y hepaticojejunostomy and gastrojejunostomy and necessary palliation consisted of laparoscopic hepaticojejunostomy alone.
  
  
  RESULTS
  A total of 48 patients received laparoscopic surgical palliation. Morbidity rate was 33.3% and mortality was 2.08%. There was no need for late surgeries in any of the patients.
  
  
  CONCLUSIONS
  Surgical laparoscopic palliation is a feasible treatment option for locally advanced pancreatic cancer. Even though metallic stents are still the best palliation method for patients with systemic disease, if stents fail, the laparoscopic approach is a viable treatment.
authors.affiliation: Department of Surgery, Hospital Cosme Argerich, University of Buenos Aires, José Juan Biedma 773, CABA, Buenos Aires, Argentina, gustavokohan@yahoo.com.ar.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Kohan
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Ocampo
authors.forename: Hugo I
authors.initials: HI
authors.lastname: Zandalazini
authors.forename: Roberto
authors.initials: R
authors.lastname: Klappenbach
authors.forename: Federico
authors.initials: F
authors.lastname: Yazyi
authors.forename: Ornella
authors.initials: O
authors.lastname: Ditulio
authors.forename: Adelina
authors.initials: A
authors.lastname: Coturel
authors.forename: Carlos
authors.initials: C
authors.lastname: Canullán
authors.forename: Luis T Chiappetta
authors.initials: LT
authors.lastname: Porras
authors.forename: Juan Alvarez
authors.initials: JA
authors.lastname: Rodriguez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D013270:Stomach / Q000601:surgery*