Palliative surgery for unresectable carcinoma of the head of the pancreas, ampulla, and distal end of the common bile duct in Japan. A statistical review.

To elucidate the approximate present status of palliative surgery for unresectable carcinoma of the head of the pancreas, ampulla, and distal end of the common bile duct in Japan, surgical methods in 151 institutions were collected and analyzed. Biliary drainage alone was performed in 144 institutions (95 percent) and in 80 of them, cholecystectomy and choledochojejunostomy with a Roux-Y procedure was adopted. Gastric bypass with biliary drainage was routinely performed in 13 institutions (8.7 percent), whereas in 62 institution (41.3 percent), combined biliary and gastric drainage operations were performed as the primary procedures in selected cases. In over half the institutions, neither gastrectomy nor vagotomy was provided. Some means to alleviate the pain caused by tumor invasion were performed in about a third of the institutions (49), and about 80 percent of them added some manipulations of the celiac plexus.