Pancreatic Cancer: Stenting versus Surgery

Can-Locke, David L.

doi:10.1159/000172287

Cited by 3 publications

(1 citation statement)

References 17 publications

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“…Endoscopy currently only offers routine relief of jaundice. However, recently biliary-type metallic stents have been applied to relieve duodenal obstruction and the development of larger diameter devices has further improved this early encouraging experience (9). Also, there is some initial information on pain treatment by placement of palstic stents in pancreatic cancer patients with main duct obstruction.…”

Section: Paper Discussionmentioning

confidence: 99%

Stent or Surgery for Malignant Low Bileduct Obstruction?

et al. 1997

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The development of non-surgical techniques for the relief of malignant low bileduct obstruction has cast doubt on the best way of relieving jaundice, particularly in patients fit for surgery whose life expectancy is more than a few weeks.We did a randomised prospective controlled trial comparing endoscopic stent insertion and surgical biliary bypass in patients with malignant low bileduct obstruction. 204 patients were randomised (surgery 103, stent 101); 3 subsequently proved to have benign disease and were excluded, leaving 101 surgical and 100 stented patients for assessment. Technical success was achieved in 94 surgical and 95 stent patients, with functional biliary decompression obtained in 92 patients in both groups. In stented patients, there was a lower procedure-related mortality (3% vs 14%, p=0.01), major complication rate (11% vs 29%, p=0.02), and median total hospital stay (20 vs 26 days, p=0.001). Recurrent jaundice occurred in 36 stented patients and 2 surgical patients. Late gastric outlet obstruction occurred in 17% of stented patients and 7% of the surgical group. Despite the early benefits of stenting there was no significant difference in overall survival between the two groups (median survival: surgical 26 weeks; stented 21 weeks; p=0.065).Endoscopic stenting and surgery are effective palliative treatments with the former having fewer early treatment-related complications and the latter fewer late complications.

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Section: Paper Discussionmentioning

confidence: 99%

Stent or Surgery for Malignant Low Bileduct Obstruction?

et al. 1997

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The Role of Diagnostic Laparoscopy in Pancreatic and Periampullary Malignancies

Friess

Kleeff

Silva

et al. 1998

Journal of the American College of Surgeons

128

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L'approccio Chirurgico Nella Palliazione Del Carcinoma Pancreatico

Delrio

Izzo

Cremona

et al. 1999

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Pancreatic carcinoma is an aggressive disease and its prognosis is dismal. Patients present with an advanced stage of disease and only a small number of patients undergo resection with a curative intent; thus the 5 years survival rate is very low. Several Improvements have been made in the surgical approach with a decrease in perioperative morbidity and mortality. Results offered by chemotherapy and radiotherapy remain unsatisfactory despite a number of new drugs and considerable advancements in irradiation techniques. Jaundice, pain and gastrointestinal obstruction are the main clinical problems to be dealt with in advanced patients. Surgical palliation still represents a widely preferred option but non surgical approaches appear promising. The Authors analyse the possible options in palliation for pancreatic carcinoma. The various surgical procedures for biliary bypass are described. Hepaticojejunostomy is the operation of choice and offers the best results in terms of quality of life and time of palliation. A possible role for resective operation also in advanced cases has been proposed by some groups and is gaining wide acceptance in referral centres where low morbidity and mortality are now routine. Percutaneous and endoscopic approaches to jaundice represent a valid alternative in some patients with a low life expectancy and in those centres with a high experience. Gastrointestinal bypass in symptom-free patients or advanced cases only is an unsolved dilemma. New approaches such as locoregional chemotherapy with curative or neoadjuvant intent are also described in this paper. Many chemotherapic agents have been tested in various settings and appear to offer promising results in palliation and also, in some cases, in downstaging tumors then amenable to resection. Pain control is a major aspect in management of advanced pancreatic carcinoma. Appropriate pain therapy has to be established in all patients in order to obtain a better quality of life. Various options are available such as intraoperative alcohol injection or CT guided percutaneous splanchnicectomy. Palliation in patients with pancreatic carcinoma is a major aspect of management because of the high percentage of non curable cases; multimodality approach is mandatory and all possible problems have to be dealt with in order to increase survival and, more importantly, quality of life.

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Pancreatic Cancer: Stenting versus Surgery

Cited by 3 publications

References 17 publications

Stent or Surgery for Malignant Low Bileduct Obstruction?

Stent or Surgery for Malignant Low Bileduct Obstruction?

The Role of Diagnostic Laparoscopy in Pancreatic and Periampullary Malignancies

L'approccio Chirurgico Nella Palliazione Del Carcinoma Pancreatico

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