Endoscopic and operative palliation strategies for pancreatic ductal adenocarcinoma.
Malignant biliary obstruction, duodenal, and gastric outlet obstruction, and tumor-related pain are the complications of unresectable pancreatic adenocarcinoma that most frequently require palliative intervention. Surgery involving biliary bypass with or without gastrojejunostomy was once the mainstay of treatment in these patients. However, advances in non-operative techniques-most notably the widespread availability of endoscopic biliary and duodenal stents-have shifted the paradigm of treatment away from traditional surgical management. Questions regarding the efficacy and durability of endoscopic stents for biliary and gastric outlet obstruction are reviewed and demonstrate high rates of therapeutic success, low rates of morbidity, and decreased cost. Surgery remains an effective treatment modality, and still produces the most durable relief in appropriately selected patients.
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Alexander
A
Stark
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. Electronic address: joehines@mednet.ucla.edu.
O Joe
OJ
Hines
D001662:Biliary Tract Surgical Procedures; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000601:surgery*; D004386:Duodenum / Q000473:pathology / Q000601:surgery; D016145:Endoscopy, Digestive System / Q000379:methods; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery*