COST-EFFECTIVE ANALYSIS OF SURGICAL PALLIATION VERSUS ENDOSCOPIC STENTING IN THE MANAGEMENT OF UNRESECTABLE PANCREATIC-CANCER

Background: Ductal carcinoma of the pancreas is unresectable for cure in the majority of patients. We reviewed our results and cost effectiv eness of surgical and endoscopic biliary bypass for unresectable pancr eatic cancer to evaluate the comparable outcomes. Methods: Between 199 0 and 1992, 136 patients were managed operatively or endoscopically fo r pancreatic carcinoma. Excluding potentially curative resections and patients without follow-up, 34 patients endoscopically stented and 32 patients surgically bypassed were evaluated. Results: Mean patient age was older (72.1 vs. 69.3 years) but average performance status was co mparable (0.8 vs. 0.9 Eastern Cooperative Oncology Group grading) in t he medical treatment group. The initial hospital stay was significantl y longer for surgical patients (mean 14 vs. 7 days, p < 0.001), with h igher average charges ($18,325 vs. $9,663). Twelve stented patients re quired rehospitalization (average charge of $4,029), and eight surgica l patients were readmitted (average charge of $6,776). An average of 1 .7 stent changes (average charge $1,190) were required. Mean survival was longer for the stented group (9.7 vs. 7.3 months, p = 0.13). Concl usions: Endoscopic stenting for unresectable pancreatic cancer provide s equivalent duration of survival at reduced cost and shorter hospital stay, although subsequent stent changes are necessary. When curative resection is not possible, endoscopic biliary drainage should be consi dered a good first choice for palliative management.