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Choledochoduodenostomy for palliation in unresectable pancreatic cancer
L A DiFronzo1, S Egrari, T X O'Connell
1Kaiser Permanente Medical Center, Los Angeles, Calif, USA.
Objective:
To determine whether choledochoduodenostomy provides adequate long-term palliation of obstructive jaundice in unresectable pancreatic cancer.
Design:
Consecutive case series.
Setting:
Tertiary referral center.
Patients:
From 1980 to 1997, 79 consecutive patients (45 men, 34 women; mean age, 67.8 years) with biopsy-proved pancreatic cancer found to be unresectable at operation.
Intervention:
All patients had resectable disease by preoperative criteria. At exploratory laparotomy, unresectability was determined by the presence of liver or peritoneal metastases, encasement of major vascular structures by tumor, and/or celiac lymph node involvement. Choledochoduodenostomy for biliary bypass was performed in 71 (90%) of 79 patients; Roux-en-Y choledochojejunostomy was performed in the remaining 8 patients.
Main Outcome Measures:
Resolution of jaundice, duration of hospital stay, mean survival, postoperative complications, and evidence of recurrent biliary obstruction.
Results:
All patients experienced rapid resolution of jaundice. Average hospital stay was 8.3 days. Mean survival after operation was 13.1 months (range, 2 weeks to 62 months). Postoperative mortality was 3%. There were no biliary or duodenal leaks. Four patients (6%) required hospitalization for gastrointestinal hemorrhage; however, only 1 (1%) was from peptic ulceration. No patient developed recurrent biliary obstruction.
Conclusions:
Choledochoduodenostomy provides rapid, long-lasting relief of jaundice, with little morbidity and a low rate of duodenal ulceration, and is the palliative operation of choice when patients are found to have unresectable disease at operation or when stenting procedures fail.