Optimization of palliative treatment for pancreatic carcinoma

Only an interdisciplinary approach between surgeon, medical onoclogist and radiologist may allow the optimisation of palliative treatment for pancreat ic carcinoma. If imaging diagnostics do not allow to decide about the resec tability of a tumour, an explorative laparotomy should be performed, unless this is precluded by comorbidity. Due to similar morbidity and mortality, but better long-term results, a choloedocho-jejunostomy should be performed for intra-operatively unresectable tumors in favour of a cholecysto-jejuno stomy. In selected patients a gastro-enterostomy may be indicated. However? this is not justified prophylactically. If imaging diagnostics show defini te signs of unresectability in the absence of a gastric outlet obstruction, the treatment depends on the general condition of the patient: Insertion o f a pigtail-catheter is sufficient for patients in poor general condition a nd a short life expectancy; metal wallstents should be preferred for patien ts in good general condition and a life expectancy in excess of six months, due to better results regarding quality of life. Chemoabiation of the celi ac plexus is an useful method to control the severe pain, which is common i n these patients; radiotherapy or analgesic therapy may be used alternative ly.