Biliary stent or surgical bypass in unresectable pancreatic cancer with obstructive jaundice

To investigate the effects of surgical and non-surgical palliation of jaundice in unresectable pancreatic carcinoma this retrospective study was performed. Between 1980 and 1983 90 patients were treated of whom 54 (69%) were jaundiced. Of these 36 were treated with biliary bypass (67%), four underwent resection (7%), five were treated by percutaneous drainage (9%) and nine (17%) were in such poor general condition that no treatment for jaundice was possible. Ninety-eight patients were treated between 1984 and 1987 when the initial approach to palliation of jaundice was endoscopic stenting. Transhepatic drainage was used only if stenting failed, and operation only if both non-surgical methods failed. Seventy-two of the 98 patients (73%) were jaundiced, of whom 18 (25%) received a stent placed endoscopically, 11 (15%) underwent transhepatic drainage, 27 (38%) underwent biliary bypass, and 14 (19%) underwent pancreatic resection. Significantly fewer patients in the second group could not be treated because of their poor general condition (n = 2, 3%, p less than 0.02). There were no differences among the methods in overall and 30 day complication rates, or the length of hospital stay, but the late complication rate was 1/63 (2%) for biliary bypass compared with 7/29 (24%) for biliary stenting (p less than 0.001). The difference was because of the high incidence of blockage of the stents causing recurrent jaundice, but the stents could easily be replaced. There was no difference in mortality between the two periods. We conclude that stenting is an acceptable alternative to biliary decompression in the treatment of obstructive jaundice in unresectable pancreatic cancer.