Interventional radiology in palliative care for pancreatic carcinoma

Aims and background: Pancreatic carcinoma often involves the head of the pa ncreas and obstructive jaundice is its earliest sign. It sometimes extends to celiac plexus and duodenum causing pain and bowel obstruction respective ly. Only 20% of cases are totally resectable (stage I) at the time of diagn osis. Palliative treatment is the only available therapeutic option when th e tumor extends surrounding organs or has given lymphatic metastases (stage II, III, IV). The aim of this study Is to evaluate effectiveness of interventional radiol ogy procedures on unresectable cancer palliative treatment. Methods: Betwee n Jan 90 and Sep 98, 195 patients with unresectable pancreatic carcinoma re ceived percutaneous treatments. They were 104 males and 91 females with mea n age of 74 years (range, 48-95). One hundred eighty four patients underwen t biliary drainage, six patients underwent celiac plexus block, two patient s were treated by bowel stenting. Two patients received both biliary and bo wer stents, one patient underwent biliary drainage and celiac plexus block. Results: Jaundice treatment was performed by placement of drainage cathete rs in 48 patients, polymeric endoprostheses in 58 and metallic stents in 77 (67 Wallstents). Biliary drainage was successful in ail cases obtaining ap preciable bilirubin serum levels reduction and jaundice regression in 175 p atients (95%). In 44 patients Wallstents were placed during a single PTC se ssion time ("one step" technique). In 21 cases (11%) peri-procedural compli cations occurred. Follow-up related to 85 patients shows survival rate cove red between 30 and 570 days (mean, 142). Best survival values occurred in p atients who underwent one step" technique. Celiac plexus block was successful in 5/7 cases (71%) with no complications , total pain relief and withdrawal of pharmacological treatment Bowel stenting achieved complete recanalization of intestinal loop in 2 cas es but showed troubles related to management of these patients. Conclusions : In patients with unresectable pancreatic carcinoma palliation is the only therapeutic option and has the purpose to achieve biliary tree decompressi on and eliminate jaundice associated symptoms, improving quality of life an d reducing hospitalization. Jaundice relief is reachable by surgical, endos copic or percutaneous approach. Surgical palliation is characterized by dis advantageous cost-effectiveness rate. Endoscopic and percutaneous palliatio ns are alternative, although, in selected patients, percutaneous Wallstents placement by one step technique is perhaps the most successful procedure, showing high rate of technical outcome with low complications and short tim e spent in hospital. Celiac plexus block under CT guidance constitutes a reliable method for man agement of pain. At present bowel stricture treatment is surgical.