SURGICAL PALLIATION FOR DUCTAL ADENOCARCINOMA OF THE PANCREAS

The short and long term outcomes of operative palliation for unresecte d ductal adenocarcinoma were evaluated in a critical review of 319 pat ients from 1972-1990. A total of 154 of 243 operated patients had pall iative procedures, including biliary drainage in 86 per cent and combi ned biliary drainage and gastrojejunostomy in 53 per cent. Overall mor tality rate was 13 per cent; one-half of the patients had some complic ation during their remaining Lifetime. Biliary enteric anastomoses pro vided clinical relief of jaundice in 78 per cent of patients at hospit al discharge; jaundice recurred in 16.7 per cent. The overall outcomes of choledochojejunostomy, cholecystojejunostomy, and choledochoduoden ostomy were similar and superior to biliary intubation. Choledochojeju nostomy was associated with a trend toward longer survival. Gastrojeju nostomy did not affect overall results. However, upper gastrointestina l hemorrhage was more frequent when gastrojejunostomy was added to bil iary bypass. Late duodenal obstruction developed in 6 per cent of pati ents initially treated by biliary drainage alone, Mean survival was 8. 1 monas; 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 mo st patients. Selective, rather than routine, gastrojejunostomy is reco mmended.