BACKGROUND: Unresectable tumors of the pancreatic head are encountered in up to 20% of patients taken for resection. The objective of this study was to evaluate the complications and outcome associated with palliative surgical procedures to help guide management decisions in these patients. METHODS: Patients with pancreatic head adenocarcinoma taken to the operating room with curative intent who did not undergo pancreatectomy were evaluated. RESULTS: From 1997 to 2013, 50 patients were explored and found be unresectable due to M1 disease (n = 27, 54.0%) or vascular invasion (n = 23, 46.0%). Among unresectable patients, 34 (68.0%) had a palliative procedure performed including double bypass (n = 13), biliary bypass (n = 7), gastrojejunostomy (n = 5), or cholecystectomy (n = 9). Complications occurred in 22 patients (44.0%), and patients who had a palliative operation had a longer hospital stay and more major complications. Overall survival was reduced in patients treated with a palliative operation. CONCLUSIONS: Despite advancements in endoscopic palliation, operative bypasses are still commonplace in patients with unresectable pancreatic head cancer. In this study, patients treated with operative procedures had a high rate of complications without a notable improvement in outcome. These findings highlight the importance of identifying unresectable disease prior to surgery and support a selective approach to palliative operations.
BACKGROUND: Unresectable tumors of the pancreatic head are encountered in up to 20% of patients taken for resection. The objective of this study was to evaluate the complications and outcome associated with palliative surgical procedures to help guide management decisions in these patients. METHODS:Patients with pancreatic head adenocarcinoma taken to the operating room with curative intent who did not undergo pancreatectomy were evaluated. RESULTS: From 1997 to 2013, 50 patients were explored and found be unresectable due to M1 disease (n = 27, 54.0%) or vascular invasion (n = 23, 46.0%). Among unresectable patients, 34 (68.0%) had a palliative procedure performed including double bypass (n = 13), biliary bypass (n = 7), gastrojejunostomy (n = 5), or cholecystectomy (n = 9). Complications occurred in 22 patients (44.0%), and patients who had a palliative operation had a longer hospital stay and more major complications. Overall survival was reduced in patients treated with a palliative operation. CONCLUSIONS: Despite advancements in endoscopic palliation, operative bypasses are still commonplace in patients with unresectable pancreatic head cancer. In this study, patients treated with operative procedures had a high rate of complications without a notable improvement in outcome. These findings highlight the importance of identifying unresectable disease prior to surgery and support a selective approach to palliative operations.
Authors: A Hedjoudje; A Sportes; S Grabar; A Zhang; S Koch; L Vuitton; F Prat Journal: United European Gastroenterol J Date: 2018-10-26 Impact factor: 4.623
Authors: Nina P Tamirisa; Abhishek D Parmar; Gabriela M Vargas; Hemalkumar B Mehta; E Molly Kilbane; Bruce L Hall; Henry A Pitt; Taylor S Riall Journal: Ann Surg Date: 2016-02 Impact factor: 12.969
Authors: Reem Z Sharaiha; Nikhil A Kumta; Amit P Desai; Ersilia M DeFilippis; Moamen Gabr; Alex M Sarkisian; Sanjay Salgado; Jennifer Millman; Andrea Benvenuto; Michelle Cohen; Amy Tyberg; Monica Gaidhane; Michel Kahaleh Journal: Surg Endosc Date: 2016-04-29 Impact factor: 4.584
Authors: Lydia G M van der Geest; Nadia Haj Mohammad; Marc G H Besselink; Valery E P P Lemmens; Johanneke E A Portielje; Hanneke W M van Laarhoven; J Hanneke W Wilmink Journal: Cancer Med Date: 2017-10-16 Impact factor: 4.452