Are there indications for palliative resection in pancreatic cancer?

Controversy exists about the indication for a palliative pancreatoduodenect omy. A palliative resection for patients with a pancreatic carcinoma can be performed safely nowadays with low mortality and acceptable morbidity in c enters with experience. The early results in terms of mortality and morbidi ty are not different from resections with curative intent or even after byp ass surgery. The procedure seems effective for controlling symptoms of the disease, and the quality of life after a palliative resection is acceptable and not morse than after bypass surgery. It is, however, still doubtful wh ether the incidence of symptom recurrence, such as jaundice, obstruction, a nd pain, is lower after resection than after by pass surgery. The longer su rvival after palliative resection could also be due to patient selection an d postoperative treatment. There are no randomized trials to prove the supe riority of palliative resection over bypass surgery. The safety of pancreat ic resection for cancer has already changed the policy in centers with expe rience, and surgeons are more willing to perform a resection because the re sults are better or at least the same as after bypass surgery. There are, h owever, no results to confirm that a palliative resection should be perform ed routinely or to justify resection as a debulking procedure.