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Palliative surgical bypass for pancreatic and peri-ampullary cancers
Samrat Mukherjee1, Hemant M Kocher, Robert R Hutchins
1Barts and the London NHS Trust, Barts and the London HPB Centre, The Royal London Hospital Whitechapel, London, E1 1BB, UK. docsamrat@yahoo.com
Background:
The optimal method of palliation for patients with unresectable pancreatic and peri-ampullary cancer (PAC) is controversial with surgical bypass or endoscopic stenting, each having advantages and disadvantages.
Aims:
We analysed short term outcomes and survival for all patients undergoing surgical palliative bypass procedures.
Materials And Methods:
All patients undergoing palliative surgical bypass for unresectable PAC from Aug 1999 to July 2007 were identified from our database. Outcomes analysed were peri-operative morbidity, mortality, and overall survival with comparisons from contemporaneous literature.
Results:
One hundred eight patients (median age 65 (range 36-86) years; male = 61) had palliative surgical bypass procedures for unresectable PAC. Patients underwent combined biliary and gastric bypass (n = 81, 75%), gastric bypass alone (n = 24, 22.2%) or biliary bypass alone (n = 3, 2.8%). Overall mortality was 6.5% and the morbidity was 15.7%. Median hospital stay was 11 (range 4-54) days. Median survival was 6 (95% confidence interval (CI) = 4.3-7.6) months. No re-explorations for recurrent biliary or gastric obstruction were required. Contemporaneous literature review showed similar results.
Conclusion:
Surgical bypass performed in a specialist pancreatic center can offer effective palliation for unresectable PAC, with satisfactory outcomes.
