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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 June;12(3):173-80
Unresectable cancer of the head of the pancreas and periampullary region: what is the optimal palliative procedure? Development during the past 27 years
Nardello O., Uccheddu A., Cagetti M.
Background. Improvements in pancreatic and periampullary imaging did not result in an increase in radical resections, however advances in endoscopic and radiologic technics have widened the choice among different palliative procedures.
Methods. Personal experience on 108 patients with non-sectile pancreatic and periampullary cancer observed in 27 years time is reported with the aim to determine the optimal palliative procedure.
Results. It is underlined that temporary external biliary drainage had no positive impact on postoperative complications and may be abandoned. In many cases only laparotomy provides the chance to confirm the tumor extension and to state the impossibility of resection for cure. The hepatic-jejunostomy and cholecysto-enterostomy, in high-risk patients, relieves jaundice with a lower incidence of complications and the shortest hospital stay. The gastroenteric bypass is appropriate in presence of a duodenal stenosis or an expected imminent one.
Conclusions. No surgical palliation should be considered in high-risk patients with shorter survival.