Operative procedures for unresectable pancreatic cancer: does operative bypass decrease requirements for postoperative procedures and in-hospital days?

Abstract

In this study, duodenal, biliary and double bypasses in unresectable patients were not associated with fewer invasive procedures following non-therapeutic laparotomy and did not appear to reduce the total number of inpatient hospital days prior to death. Continued effort to identify unresectability prior to operation is justified.

Surgical management of the cases with both biliary and duodenal obstruction

“…6,7,9,10,22 On the other hand, recurrence rate of after endoscopic treatment for malignant BO with duodenal obstruction was 34%. 2 Meta-analyses of studies comparing endoscopy and surgery for malignant BO revealed that recurrence of BO was significantly less in biliary bypass compared to biliary stent.…”

“…24,25 With regards to GOO recurrence, studies showed that incidence rate ranges from 0% to 4.8%. 6,7,9,10,14,15,22 In addition, Hamada et al 2 reported that dysfunction of the duodenal stent was observed in 21% of the patients. Meta-analysis of studies comparing stent and surgery for malignant GOO also revealed that reintervention was less required in gastrojejunostomy compared to stent placement.…”

“…In some cases, hepaticoduodenostomy, choledochojejunostomy, choledochoduodenostomy, cholecystojejunostomy and cholecystoduodenostomy can also be acceptable options. 6,7 Based on our previous study, we also utilize hepaticocholecystojejunostomy for bilio-enteric anastomosis in selected cases (Fig. 1, 2).…”

“…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 …”

“…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%).…”