Original Paper

A Continuing Role for Surgical Bypass in the Palliative Treatment of Pancreatic Carcinoma
A.M. Isla, T. Worthington, A.K. Kakkar, R.C.N. Williamson

Department of Surgery, Royal Postgraduate Medical School of Hammersmith Hospital, London, UK

Address of Corresponding Author

Dig Surg 2000;17:143-146 (DOI: 10.1159/000018817)

  Key Words

• Biliary bypass
• Pancreatic carcinoma
• Palliation
• Obstructive jaundice

  Abstract

Background: The use of palliative surgery for irresectable pancreatic cancer has been challenged by the advent of non-operative stenting, but it may still be appropriate for selected patients. Methods: Single-loop biliary and gastric bypass was carried out in 56 patients (mean age 60 years) with carcinomas of the pancreatic head that were irresectable because of vascular invasion or distant spread. In 42 patients without a preoperative tissue diagnosis, ductal carcinoma was confirmed by biopsy of the primary (n = 20) or secondary (n = 22) tumour. Preoperative biliary decompression in 31 patients led to positive bile cultures in 22 of 24 patients sampled. Results: There were no deaths in hospital or within 30 days. Complications in 20 patients (35%) included three biliary leaks, two of which required temporary percutaneous stents. The median postoperative hospital stay was 14 days. No re-operations were required before death, though 2 patients required percutaneous stenting of the biliary anastomosis for recurrent jaundice, 1 of whom had a radiation-induced stricture. The median survival was 6 (range 2-21) months. Conclusion: Combined biliary and gastric bypass can be carried out with reasonable safety and remains a useful option for patients with potentially resectable tumours and an anticipated life expectancy of at least 6 months.

Copyright © 2000 S. Karger AG, Basel

  Author Contacts

Alberto M. Isla, MD
Department of Surgery, ICSM
Hammersmith Hospital, Du Cane Road
London W12 ONN (UK)
Tel. +44 181 3833210, E-Mail aisla@rpms.ac.uk

  Article Information

Received: Received: March 30, 1999
Accepted: August 16, 1999
Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 2, Number of References : 12