A continuing role for surgical bypass in the palliative treatment of pancreatic carcinoma

Background: The use of palliative surgery for irresectable pancreatic cance r has been challenged by the advent of non-operative stenting, but it may s till be appropriate for selected patients. Methods: Single-loop biliary and gastric bypass was carried out in 56 patients (mean age 60 years) with car cinomas of the pancreatic head that were irresectable because of vascular i nvasion or distant spread. In 42 patients without a preoperative tissue dia gnosis, ductal carcinoma was confirmed by biopsy of the primary (n = 20) or secondary (n = 22) tumour. Preoperative biliary decompression in 31 patien ts led to positive bile cultures in 22 of 24 patients sampled. Results: The re were no deaths in hospital or within 30 days. Complications in 20 patien ts (35%) included three biliary leaks, two of which required temporary perc utaneous stents. The median postoperative hospital stay was 14 days. No re- operations were required before death, though 2 patients required percutane ous stenting of the biliary anastomosis for recurrent jaundice, 1 of whom h ad a radiation-induced stricture. The median survival was 6 (range 2-21) mo nths. Conclusion: Combined biliary and gastric bypass can be carried out wi th reasonable safety and remains a useful option for patients with potentia lly resectable tumours and an anticipated life expectancy of at least 6 mon ths. Copyright (C) 2000 S. Karger AG, Basel.