[Optimizing palliative therapy in pancreatic carcinoma]

Only an interdisciplinary approach between surgeon, medical oncologist and radiologist may allow the optimisation of palliative treatment for pancreatic carcinoma. If imaging diagnostics do not allow to decide about the resectability of a tumour, an explorative laparotomy should be performed, unless this is precluded by comorbidity. Due to similar morbidity and mortality, but better long-term results, a choloedocho-jejunostomy should be performed for intra-operatively unresectable tumors in favour of a cholecysto-jejunostomy. In selected patients a gastro-enterostomy may be indicated. However, this is not justified prophylactically. If imaging diagnostics show definite signs of unresectability in the absence of a gastric outlet obstruction, the treatment depends on the general condition of the patient: Insertion of a pigtail-catheter is sufficient for patients in poor general condition and a short life expectancy; metal wallstents should be preferred for patients in good general condition and a life expectancy in excess of six months, due to better results regarding quality of life. Chemoablation of the celiac plexus is an useful method to control the sever pain, which is common in these patients; radiotherapy or analgesic therapy may be used alternatively.