Current role of palliative interventions in advanced pancreatic cancer

Abstract

Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Unfortunately, at diagnosis, most patients are not candidates for curative resection. Surgical palliation, a procedure performed with the intention of relieving symptoms or improving quality of life, comes to the forefront of management. This article reviews the palliative management of unresectable pancreatic cancer, including obstructive jaundice, duodenal obstruction and pain control with celiac plexus block. Although surgical bypasses for both biliary and duodenal obstructions usually achieve good technical success, they result in considerable perioperative morbidity and mortality, even when performed laparoscopically. The effectiveness of self-expanding metal stents for biliary drainage is excellent with low morbidity. Surgical gastrojejunostomy for duodenal obstruction appears to be best for patients with a life expectancy of greater than 2 mo while endoscopic stenting has been shown to be feasible with good symptom relief in those with a shorter life expectancy. Regardless of the palliative procedure performed, all physicians involved must be adequately trained in end of life management to ensure the best possible care for patients.

Surgical exploration without resection in pancreatic and periampullary tumors: Report from a national database

“…While palliative surgery has decreased over time, the proportion of intraoperative endoscopic procedures, primarily with self-expanding metallic stents, has increased. These interventions are, unlike palliative surgery, usually performed only in case of a symptomatic biliary and/or gastric outlet obstruction, and can safely be performed both during surgery or postoperatively 26 . Endoscopic procedures are favorable for several reasons.…”

Progress in the Application of Interventional Technique in Malignant Obstructive Jaundice

“…Occlusion after biliary stent implantation is the most common complication. In recent years, coated stents and drug-eluting stents have become the focus of research on the prevention of restenosis after stent implantation [10,11]. Coated stents are prone to displacement, which increases the incidence of cholecystitis and pancreatitis.…”

Patient selection in palliative surgery: Defining value

“…Common indications for palliative procedures in pancreatic cancer are gastric outlet obstructions and obstructive jaundice, both of which can be intervened upon by operative and endoscopic approaches, complicating the cost analysis . Roy et al performed a retrospective review of Medicare's MedPAR database, identifying 774 patients who underwent intervention for gastric outlet obstruction due to pancreaticobiliary obstructions from 2007‐2008 .…”