Surgical management of unresectable carcinoma of the pancreas

The benefits palliative surgery for carcinoma of the pancreas were reviewed in over 8,000 patients in the English literature from 1965 to 1980. The results suggest that biliary bypass prolongs survival, relieves the sequelae of extrahepatic biliary obstruction, and improves the quality of survival. Cholecystojejunostomy to a jejunal loop is easily and safely constructed and should be used instead of choledochojejunostomy unless tumor encroaches near the choledochocystic junction. Percutaneous internal biliary drainage can offer an effective alternate form of palliation in the poor-risk operative candidate or in the patient known to have nonresectable disease. Concomitant gastroenterostomy is recommended in all patients undergoing surgery when prolonged survival is expected. The addition of gastroenterostomy does not increase the operative mortality rate in these patients. If gastroenterostomy is not performed, 13% can be expected to develop subsequent duodenal obstruction. Intraoperative chemical splanchniectomy with 50% ethanol is effective in relieving pancreatic cancer-related pain. Surgical intervention, as well as providing diagnosis and feasibility of resection, also offers considerable palliative benefit for the patient with nonresectable pancreatic cancer.