Advertisement

Laparoscopic Biliary and Gastric Bypass

  • Kevin C. Conlon
  • Stanley W. Ashley

Abstract

In the United States, pancreatic cancer is the fourth leading cause of cancer death in men and the fifth in women (1). It is estimated that, in 1998, 27,600 new cases will be diagnosed, with the majority dying of their disease (2). In spite of some recent progress in diagnosis and treatment, the outlook for the majority of patients remains bleak. Adenocarcinoma accounts for more than 90% of pancreatic tumors, and is a particularly aggressive lesion; at the time of diagnosis, the tumor is confined to the pancreas in fewer than 10% of patients, 40% have locally advanced disease, and over 50% have distant spread (3,4). More than 95% of patients eventually die of their disease, most within the first year (5). Radiation and chemotherapy have been shown to be of only marginal benefit (6,7); the primary mode of therapy continues to be surgical resection (8). However, only 20–25% of patients actually prove to have resectable disease at the time of exploration.

Keywords

Pancreatic Cancer Gastric Bypass Cystic Duct Gastric Outlet Obstruction Staple Anastomosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Raijman I and Levin B. Exocrine tumors of the pancreas. In: Go VLW (eds). The pancreas: biology, pathobiology, and disease, 2-nd ed., Raven, New York, 1993; pp. 899–912.Google Scholar
  2. 2.
    Cancer facts and figures—1997. American Cancer Society, Atlanta, GA.Google Scholar
  3. 3.
    Singh SM and Reber HA. Surgical palliation for pancreatic cancer. Surg Clin N Am 1989; 69:599–611.PubMedGoogle Scholar
  4. 4.
    Singh SM, Longmire WP, Jr., and Reber HA. Surgical palliation for pancreatic cancer. The UCLA experience. Ann Surg 1990; 212:132–139.Google Scholar
  5. 5.
    Warshaw AL and Swanson RS. Pancreatic cancer in 1988. Possibilities and probabilities. Ann Surg 1988; 208:541–553.CrossRefGoogle Scholar
  6. 6.
    Gastrointestinal Tumor Study Group. Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of advanced pancreatic cancer. Cancer 1987; 59:2006–2010.CrossRefGoogle Scholar
  7. 7.
    Gastrointestinal Tumor Study Group. Treatment of locally unresectable carcinoma of the pancreas. Comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988; 80:751–755.Google Scholar
  8. 8.
    Warshaw AL, Gu GY, Wittenberg J, and Waxman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg 1990; 125:230–233.PubMedCrossRefGoogle Scholar
  9. 9.
    Warshaw AL, Tepper JE, and Shipley WU. Laparoscopy in the staging and planning of therapy for pancreatic cancer. Am J Surg 1986; 158:76–80.CrossRefGoogle Scholar
  10. 10.
    Conlon KC, Dougherty E, Klimstra DS, Coit DG, Turnbull ADM, and Brennan MF. The value of minimal access surgery in the staging of potentially resectable peri-pancreatic malignancy. Ann Surg 1996; 223:134–140.PubMedCrossRefGoogle Scholar
  11. 11.
    Watanapa P and Williamson RCN. Surgical palliation for pancreatic cancer: Developments during the past two decades. Br J Surg 1992; 79:8–20.PubMedCrossRefGoogle Scholar
  12. 12.
    DeRooij PD, Rogatko A, and Brennan MF. Evaluation of palliative surgical procedures in unresectable pancreatic cancer. Br J Surg 1991; 78:1053–1058.CrossRefGoogle Scholar
  13. 13.
    Nathanson LK, Shimi S, and Cuschieri A. Sutured laparoscopic cholecystojejunostomy evolved in a animal model. J R Coll Surg Edinburgh 1993; 37:215–220.Google Scholar
  14. 14.
    Patel AG, McFadden DW, Hines OJ, Reber HA, and Ashley SW. Palliation for pancreatic cancer. Feasibility of laparoscopic cholecytojejunostomy and gastrojejunostomy in a porcine model. Surg Endosc 1996; 10:639–643.Google Scholar
  15. 15.
    Rhodes M, Nathanson L, and Fielding G. Laparoscopic biliary and gastric bypass: a useful adjunct in the treatment of carcinoma of the pancreas. Gut 1990; 36:778–780.CrossRefGoogle Scholar
  16. 16.
    Shimi S., Banting S., and Cuschieri A. Laparoscopy in the management of pancreatic cancer: endoscopic cholecytojejunostomy for advanced disease. Br J Surg 1992; 79:317–319.PubMedCrossRefGoogle Scholar
  17. 17.
    Fletcher DR and Jones RM. Laparoscopic cholecystjejeunostomy as palliation for obstructive jaundice in inoperable carcinoma of the pancreas. Surg Endosc 1992; 6:147–149.PubMedCrossRefGoogle Scholar
  18. 18.
    Haswasli A. Laparoscopic cholecysto-jejunostomy for obstructing pancreatic cancer: technique and report of two cases. J Laparoendosc Surg 1992; 2:351–355.CrossRefGoogle Scholar
  19. 19.
    Wilson RG and Varma JS. Laparoscopic gastroenterostomy for malignant duodenal obstruction. Br J Surg 1992; 79:1348.PubMedCrossRefGoogle Scholar
  20. 20.
    Rangraj MS, Mehta M, Zale G, Maffucci L, and Herz B. Laparoscopic gastrojejunostomy: a case presentation. J Laparoendosc Surg 1994; 4:81–87.PubMedCrossRefGoogle Scholar
  21. 21.
    Conlon KC and Minnard EA. The value of laparoscopic staging in upper gastrointestinal malignancy. Oncologist 1997; 2:10–17.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Kevin C. Conlon
  • Stanley W. Ashley

There are no affiliations available

Personalised recommendations