Evaluation of palliative surgical procedures in unresectable pancreatic cancer

To update our experience with palliative surgical procedures in unresectable adenocarcinoma of the pancreas, the records of 297 patients surgically treated at Memorial Sloan-Kettering Cancer Center were reviewed. Between October 1983 and November 1989, 117 patients underwent exploratory laparotomy as a single procedure: 24 patients had gastric bypass, 38 biliary bypass, and 118 both gastric and biliary bypass. The postoperative in-hospital mortality rate was 4.4 per cent. Overall morbidity was 29.7 per cent; the morbidity rate in patients with a double bypass was 29.7 per cent. Median (s.e.m.) survival was 231(20.3) days. Statistical analysis showed a significantly increased risk of morbidity in patients who underwent one therapeutic and one prophylactic bypass. Survival was decreased in patients who had a therapeutic gastric bypass (median(s.e.m.) survival 136(70.2) days) or a combination of two therapeutic bypasses (median(s.e.m.) survival 93(85.9) days). These data emphasize the poor prognosis of patients with pancreatic adenocarcinoma who cannot be resected. The need for therapeutic double bypass is a bad prognostic indicator, and a prophylactic bypass added to a therapeutic bypass increases morbidity without prolonging survival.