Bypass Surgery Versus Palliative Pancreaticoduodenectomy in Patients with Advanced Ductal Adenocarcinoma of the Pancreatic Head, with an Emphasis on Quality of Life Analyses

Schniewind, Bodo; Bestmann, Beate; Kurdow, Roland; Tepel, Juergen; Henne‐Bruns, Doris; Faendrich, Fred; Kremer, Bernd; Kuechler, T.

doi:10.1245/s10434-006-9172-z

Cited by 46 publications

(39 citation statements)

References 27 publications

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“…23 The most common morbidity after double bypass is DGE of which incidence was up to 20%. 19 Lesurtel et al 6 reported that the position of gastrojejunostomy (antecolic or retrocolic) did not influence incidence of DGE after double bypass for unresectable pancreatic and periampullary cancer. The two RCTs showed that postoperative morbidity incidence rate was comparable between double bypass and biliary bypass alone.…”

Section: Perioperative Outcomesmentioning

confidence: 99%

“…13 Outcomes Table 1 shows outcomes of biliary and gastrointestinal double bypass from the literature. 4,6,7,9,10,[14][15][16][17][18][19][20][21][22] Among the 14 studies, two were prospective randomized controlled trials (RCTs) comparing double bypass and biliary bypass alone, 14,15 eight studies were retrospective comparative studies 4,7,10,[16][17][18][19][20] and the remaining were case series. 6,9,21,22 A B …”

Section: Surgical Proceduresmentioning

confidence: 99%

Section: Perioperative Outcomesmentioning

confidence: 99%

“…6,9,14,16,[18][19][20] Double bypass was significantly longer than exploration laparotomy or single bypass, but shorter than pancreaticoduodenectomy. 14,16,[18][19][20] Mortality rates ranged from 0% to 7%, and morbidity rates ranged from 3% to 50%. 4,6,7,9,10,[14][15][16][17][18][19][20][21][22] The morbidity rates were relatively high probably because the preoperative condition of a symptomatic patient is usually suboptimal due to medical problems caused by the disease (i.e., jaundice secondary to BO, undernourishment secondary to GOO).…”

Section: Perioperative Outcomesmentioning

confidence: 99%

“…14,16,[18][19][20] Mortality rates ranged from 0% to 7%, and morbidity rates ranged from 3% to 50%. 4,6,7,9,10,[14][15][16][17][18][19][20][21][22] The morbidity rates were relatively high probably because the preoperative condition of a symptomatic patient is usually suboptimal due to medical problems caused by the disease (i.e., jaundice secondary to BO, undernourishment secondary to GOO). Furthermore, our analysis showed that prophylactic double bypass performed for unresectable pancreatic cancer patients without symptoms of BO and GOO was associated with lower morbidity rate (3%).…”

Section: Perioperative Outcomesmentioning

confidence: 99%

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Surgical management of the cases with both biliary and duodenal obstruction

Miyasaka

Ohtsuka

Velasquez

et al. 2018

Int J Gastrointest Interv

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Endoscopic management is presently the recommended first-line of treatment for biliary strictures. However, surgery still has an important role especially for biliary obstruction (BO) with duodenal obstruction. Even though endoscopic treatment for concurrent BO and gastric-outlet obstruction has been proposed, it is still not widespread. Duodenal obstruction is often associated with malignant BO which makes endoscopic treatment more challenging. Biliary and gastrointestinal double bypass with Roux-en-Y hepaticojejunostomy and gastrojejunostomy is the most common surgical intervention for malignant biliary and gastric-outlet obstruction. A variety of procedures of biliary bypass and gastrointestinal bypass have been reported. According to several studies, mortality rates range from 0% to 7%, while morbidity rates range from 3% to 50%. Higher morbidity was observed in symptomatic patients caused by the disease. Most common morbidity after double bypass was delayed gastric emptying. Recurrence of BO and gastric-outlet obstruction was less frequently seen after surgical bypass compared to after endoscopic treatment. Minimally invasive approach has been applied to double bypass. Studies showed that laparoscopic double bypass has a shorter hospital stay and reduced postoperative pain; however, due to its technical demand, it is still presently an uncommon procedure. Robotic bypass surgery may resolve this issue in the future. Further analyses of outcomes of both surgical and endoscopic treatments are necessary to establish better and suitable palliation options for concurrent biliary and duodenal obstruction caused by unresectable malignant tumors.

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Section: Perioperative Outcomesmentioning

confidence: 99%

Section: Surgical Proceduresmentioning

confidence: 99%

Section: Perioperative Outcomesmentioning

confidence: 99%

Section: Perioperative Outcomesmentioning

confidence: 99%

Section: Perioperative Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Surgical management of the cases with both biliary and duodenal obstruction

Miyasaka

Ohtsuka

Velasquez

et al. 2018

Int J Gastrointest Interv

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How Should Surgeons Communicate About Palliative and Curative Intentions, Purposes, and Outcomes?

Binkley

2021

AMA Journal of Ethics

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How surgeons describe procedures should be accurate, precise, and concordant with patients' values. By focusing on intention rather than realistic goals, terms like curative and palliative, when applied to highstakes operations, such as a Whipple pancreaticoduodenectomy, can be confusing to patients. This case commentary argues that surgeons' language choices can influence patients' decisions and experiences.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case LL is a 66-year-old patient with a pancreatic head adenocarcinoma. In consultation, Dr B recommended that LL undergo a Whipple pancreaticoduodenectomy and indicated that his "intention in doing this procedure is to cure your cancer." There were no postoperative complications, and LL completed adjuvant chemotherapy. But 18 months later, surveillance computed tomography imaging revealed a 3 cm mass in LL's right liver. Metastatic pancreatic cancer was confirmed by biopsy.LL returned to see Dr B and asked why her operation wasn't curative. Dr B explained that most often pancreatic cancer recurs and that the operation was palliative. CommentaryIn 1978, C. Gardner Child, former chairman of surgery at the University of Michigan, published a summary of 55 Whipple pancreaticoduodenectomies (PDs) he had performed from 1960 to 1978, mostly for malignancy. Child observed that the operation was "primarily a palliative surgical procedure." 1 More than 40 years later, the same operation is still being referred to in many cases as palliative. 2 However, the basis of the current designation is much different than what Child meant by palliative. Given advances in addressing major symptoms of malignancies treated by a PD, the role of true surgical palliation is significantly limited. 3,4 Palliative Whipple is thus a description that should be used with precision, as imprecise usage can compromise patient autonomy, informed consent, and physician truthfulness.

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