[Palliative treatment of pancreatic adenocarcinoma]

Carcinoma of the pancreas is the fourth leading cause of cancer related death in Western Countries. The 5-year survival for resectable tumors is 15-25%, while patients with unresectable neoplasms survive a median of 7 months. Only 30% of carcinomas of the head of pancreas and 10% of the body and tail are resectable for cure. Therefore, palliation of symptoms, namely obstructive jaundice, duodenal obstruction and pain, involve 80-90% of cases. Jaundice is frequent in tumors of the head. Palliative biliary decompression can be achieved by non surgical methods-endoscopically placed endoprostheses or percutaneous biliary drainage- or surgically. The former are indicated in patients with metastatic disease, high operative risk and short life expectancy. Surgical palliation which includes choledocho-duodenostomy, cholecystoduodenostomy, cholecystojejunostomy, hepato or choledocho-jejunostomy offers the advantage of providing a simple procedure that can treat or prevent all of the major symptoms: jaundice, duodenal obstruction and pain. Mechanical obstruction of the duodenum occurs in about 30% of cases in association with jaundice at the time of presentation and in 13-21% of patients previously subjected to biliary bypass after 8 months. Actual obstruction can be relieved by gastro-jejunostomy. Significant controversy remains concerning the role of prophylactic gastro-jejunostomy in patients requiring biliary diversion without signs of duodenal obstruction. Pain, which sooner or later affects the majority of patients, can be relieved by splanchnicectomy, either surgically or percutaneously.