Surgical palliation for ductal adenocarcinoma of the pancreas.

The short and long term outcomes of operative palliation for unresected ductal adenocarcinoma were evaluated in a critical review of 319 patients from 1972-1990. A total of 154 of 243 operated patients had palliative procedures, including biliary drainage in 86 per cent and combined biliary drainage and gastrojejunostomy in 53 per cent. Overall mortality rate was 13 per cent; one-half of the patients had some complication during their remaining lifetime. Biliary enteric anastomoses provided clinical relief of jaundice in 78 per cent of patients at hospital discharge; jaundice recurred in 16.7 per cent. The overall outcomes of choledochojejunostomy, cholecystojejunostomy, and choledochoduodenostomy were similar and superior to biliary intubation. Choledochojejunostomy was associated with a trend toward longer survival. Gastrojejunostomy did not affect overall results. However, upper gastrointestinal hemorrhage was more frequent when gastrojejunostomy was added to biliary bypass. Late duodenal obstruction developed in 6 per cent of patients initially treated by biliary drainage alone. Mean survival was 8.1 months; one-year survival was 18.2 per cent. Operative palliation for ductal cancer of the pancreas has important morbidity and mortality. Biliary enteric anastomoses provide lifelong relief of jaundice for most patients. Selective, rather than routine, gastrojejunostomy is recommended.