The Palliation of Unresectable Pancreatic Cancer: Evolution from Surgery to Minimally Invasive Modalities

Area of Science:

• Gastroenterology
• Interventional Radiology
• Surgical Oncology

Background:

• Pancreatic cancer has a low survival rate, with surgery often being palliative rather than curative.
• Traditional palliative interventions include surgical bypass and early interventional radiology techniques like percutaneous transhepatic biliary drainage (PTBD).

Purpose of the Study:

• To review the evolution of palliative interventions for pancreatic cancer.
• To highlight the shift from surgical palliation to minimally invasive endoscopic and interventional radiology techniques.

Main Methods:

• Review of historical and current interventional techniques for pancreatic cancer palliation.
• Discussion of procedures including PTBD, stent placement (plastic, SEMS), and endoscopic ultrasound (EUS)-guided interventions.
• Focus on the role of lumen-apposing metal stents (LAMSs) in creating anastomoses.

Main Results:

• Interventional radiology and endoscopic procedures have increasingly replaced surgery for palliation.
• Techniques like PTBD, ERCP with stenting, and EUS-guided interventions manage obstructive jaundice and gastric outlet obstruction.
• LAMSs enable various palliative anastomoses, significantly advancing non-surgical management options.

Conclusions:

• Minimally invasive endoscopic and interventional radiology techniques are transforming pancreatic cancer palliation.
• Lumen-apposing metal stents (LAMSs) represent a significant advancement, offering versatile non-surgical palliation.
• The field is rapidly evolving, with these newer techniques variably supplanting traditional surgical approaches.