Advertisement

Minimally Invasive Bypass Surgery for Palliation in Pancreatic Carcinoma

  • Adrian Park
  • D. W. Birch

Abstract

It is an unfortunate fact that the outlook for patients with cancer of the pancreas remains grim despite the considerable research and clinical attention focused on the disease. Pancreatic cancer (PC) is the fifth leading cause of cancer-related deaths in the United States. By most accounts, only 10% to 15% of all patients with PC are resectable for cure at initial presentation. It follows that any discussion of PC must include palliative options to provide patients relief from the ravages of the disease. Palliation for PC is directed at three primary problems: biliary obstruction, duodenal obstruction, and pain. It should be emphasized that significant progress has been made in terms of operative outcomes of patients undergoing pancreaticoduodenectomy with curative intent. As well, encouraging advances have been reported in the long-term survival of patients with resected PC.1 Unfortunately, these advances have occurred in that relatively static minority (12–15%) of patients with potentially curable disease. Thus, for the foreseeable future clinicians will need to choose from an array of options the best palliation for the majority of their patients with PC.

Keywords

Pancreatic Carcinoma Gastric Bypass Pancreatic Carcinoma Minimally Invasive Surgery Metal Stents 
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.
    Lillemoe KD, Barnes SA. Surgical palliation of unresectable pancreatic carcinoma. Surg Clin 1995; 75: 953–968.Google Scholar
  2. 2.
    Merchant NB, Conlon KC. Laparoscopic evaluation in pancreatic cancer. Semin Surg Oncol 1998; 15: 155–165.PubMedCrossRefGoogle Scholar
  3. 3.
    Rosch T, Braig C, Gain T, et al. Staging of pancreatic and ampullary carcinoma by endoscopie ultrasonography. Gastroenterology 1992; 102: 188–199.PubMedGoogle Scholar
  4. 4.
    Freeny PC, Traverso LW, Ryan JA. Diagnosis and staging of pancreatic adenocarcinoma with dynamic computed tomography. Am J Surg 1993; 195: 600–606.CrossRefGoogle Scholar
  5. 5.
    Fuhrman GM, Charnsangavej C, Abbruzze JL, et al. Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms. Am J Surg 1994; 167: 104–112.PubMedCrossRefGoogle Scholar
  6. 6.
    Bluemke DA, Cameron JL, Hruban RH, et al. Potentially resectable pancreatic adenocarcinomas. Radiology 1995; 197: 381–385.PubMedGoogle Scholar
  7. 7.
    Andren-Sandberg A, Lindberg C, Lundstedt C, et al. Computed tomography and laparoscopy in the assessment of the patient with pancreatic cancer. J Am Coll Surg 1998; 186: 35–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Fernandez-Del Castillo C, Ratnner DW, Warshaw AL. Further experience with laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Br J Surg 1995; 82: 1127–1129.CrossRefGoogle Scholar
  9. 9.
    Bemelman WA, de Wit LT, van Delden OM, et al. Diagnostic laparoscopy combined with laparoscopie ultrasonography in staging of cancer of the pancreatic head region. Br J Surg 1995; 82: 820–824.PubMedCrossRefGoogle Scholar
  10. 10.
    John TG, Greig JD, Carter DC, et al. Carcinoma of the pancreatic head and periampullary region. Ann Surg 1995; 221: 156–164.PubMedCrossRefGoogle Scholar
  11. 11.
    Minimally Invasive Bypass Surgery in Pancreatic Carcinoma 141Google Scholar
  12. 11.
    Awad SS, Colletti L, Mulholland M, et al. Multi-modality staging optimizes resectability in patients with pancreatic and ampullary cancer. Am Surg 1997; 63: 634–638.PubMedGoogle Scholar
  13. 12.
    Mortensen MB, Scheel-Hincke JD, Madsen MR, et al. Combined endoscopic ultrasonography and laparoscopic ultrasonography in the pre-therapeutic assessment of resectability in patients with upper gastrointestinal malignancies. Scand J Gastroenterol 1996; 31: 1115–1119.PubMedCrossRefGoogle Scholar
  14. 13.
    Minnard EA, Conlon KC, Hoos A, et al. Laparoscopic ultrasound enhances standard laparoscopy in the staging of pancreatic cancer. Ann Surg 1998; 2: 182–187.CrossRefGoogle Scholar
  15. 14.
    Martin JK, Goellner JR. Abdominal fluid cytology in patients with gastrointestinal malignant lesions. Mayo Clin Proc 1986; 61: 467–471.PubMedCrossRefGoogle Scholar
  16. 15.
    Warshaw AL. Implications of peritoneal cytology for staging of early pancreatic cancer. Am J Surg 1991; 161: 26–30.PubMedCrossRefGoogle Scholar
  17. 16.
    Lei S, Kini J, Kim K, et al. Pancreatic cancer, cytologic study of peritoneal washings. Arch Surg 1994; 129: 639–642.PubMedCrossRefGoogle Scholar
  18. 17.
    Leach SD, Rose JA, Lowy AM, et al. Significance of peritoneal cytology in patients with potentially resectable adenocarcinoma of the pancreatic head. Surgery 1995; 118: 472–478.PubMedCrossRefGoogle Scholar
  19. 18.
    Merchant NB, Conlon KC, Saigo P, et al. Positive peritoneal cytology predicts unresectability of pancreatic adenocarcinoma. J Am Coll Surg 1999; 188: 421–426.PubMedCrossRefGoogle Scholar
  20. 19.
    Watanapa P, Williamson RCN. Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg 1992; 79: 8–20.PubMedCrossRefGoogle Scholar
  21. 20.
    Seitz U, Soehendra N. Which stents do we need? The case for plastic stents. Endoscopy 1998; 30: A242–246.PubMedGoogle Scholar
  22. 21.
    Speer AG, Cotton PB, Macrae K. Endoscopic management of malignant biliary tract obstruction: stents of 10Fr are preferable to stents of 8Fr gauge. Gastrointest Endosc 1988; 35: 485–489.Google Scholar
  23. 22.
    Davids PH, Groen AK, Rauws EA, et al. Randomized trial of self-expanding metal stents versus polyethylene stents for distal malignant biliary obstruction. Lancet 1992; 340: 1488–1492.PubMedCrossRefGoogle Scholar
  24. 23.
    Carr-Locke TJ, Ball PJ, Connors PB, et al. Multicenter, randomized trial of Wallstent biliary endoprosthesis versus plastic stents. Gastrointest Endosc 1993; 39: A310.Google Scholar
  25. 24.
    Knyrim K, Wagner HJ, Pausch J, et al. A prospective, randomized, controlled trial of metal stents for malignant obstruction of the common bile duct. Endoscopy 1993; 25: 207–212.PubMedCrossRefGoogle Scholar
  26. 25.
    Prat F, Chapat O, Ponchon T, et al. Endoscopic palliation of malignant biliary strictures: resultsGoogle Scholar
  27. of a prospective randomized study. Endoscopy 1996; 28: S37.Google Scholar
  28. 26.
    Rosch T, Schinner S. Comparison of three different plastic and metal stents for malignant biliary obstruction. Endoscopy 1997; 29: E51.CrossRefGoogle Scholar
  29. 27.
    Shepherd HA, Royle G, Ross APR, et al. Endoscopie biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct-a randomized trial. Br J Surg 1988; 75: 1166–1168.PubMedCrossRefGoogle Scholar
  30. 28.
    Smith AC, Dowsett JF, Russell RCG, et al. Randomized trial of endoscopic stenting versus surgical bypass in malignant low bile duct obstruction. Lancet 1994; 344: 1655–1660.PubMedCrossRefGoogle Scholar
  31. 29.
    Andersen JR, Sorensen SM, Kruse A, et al. Randomized trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut 1989; 30: 1132–1135.PubMedCrossRefGoogle Scholar
  32. 30.
    van den Bosch RP, van der Schelling GP, Klinkenbijl JHG, et al. Guidelines for the application of surgery and endoprostheses in the palliation of obstructive jaundice in advanced cancer of the pancreas. Ann Surg 1994; 219: 18–24.PubMedCrossRefGoogle Scholar
  33. 31.
    Sarfeh IJ, Rypins EB, Jakowatz JG, et al. A prospective randomized clinical investigation of cholecystoenterostomy and choledochoenterostomy. Am J Surg 1988; 155: 411–414.PubMedCrossRefGoogle Scholar
  34. 32.
    Rappaport MD, Villalba M. A comparison of cholecysto-and choledochoenterostomy for obstructing pancreatic cancer. Am Surg 1990; 56: 433–435.PubMedGoogle Scholar
  35. 33.
    Rosemurgy AS, Burnett CM, Wasselle JA. A comparison of choledochoenteric bypass and cholecystoenteric bypass in patients with biliary obstruction due to pancreatic cancer. Am Surg 1989; 55: 55–60.PubMedGoogle Scholar
  36. 34.
    Tarnasky PR, England RE, Lail LM, et al. Cystic duct patency in malignant obstructive jaundice. Ann Surg 1995; 221: 265–271.PubMedCrossRefGoogle Scholar
  37. 35.
    Schob OM, Schmid RA, Morimoto AK, et al. Laparoscopic Roux-en-Y choledochojejunostomy. Am J Surg 1997; 173: 312–318.PubMedCrossRefGoogle Scholar
  38. 36.
    Franklin ME, Balli JE. Laparoscopic common bile duct bypass procedures. Semin Laparosc Surg 1997; 4: 48–53.PubMedGoogle Scholar
  39. 37.
    Soulez G, Therasse E, Oliva VL, et al. Left hepaticogastrostomy for biliary obstruction: long term results. Radiology 1997; 204: 780–786.PubMedGoogle Scholar
  40. 38.
    Bergamaschi R, Marvik R, Thoresen JEK, et al. Open versus laparoscopic gastroenterostomy for palliation in advanced pancreatic cancer. Surg Laparosc Endosc 1998; 8: 92–96.PubMedCrossRefGoogle Scholar
  41. 39.
    van der Schelling GP, van den Bosch RP, Klinkenbij JHG, et al. Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas? World J Surg 1993; 17: 128–133.PubMedCrossRefGoogle Scholar
  42. 40.
    Singh SM, Longmire WP, Reber HA. Surgical palliation for pancreatic cancer. Ann Surg 1989; 212: 132–139.CrossRefGoogle Scholar
  43. 41.
    Egrari S, O’Connell TX. Role of prophylactic gastroenterostomy for unresectable pancreatic carcinoma. Am Surg 1995; 61: 862–864.PubMedGoogle Scholar
  44. 42.
    Weaver DW, Wieneck RG, Bouwman DL, et al. Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery 1987; 102: 608–613.PubMedGoogle Scholar
  45. 43.
    Lichtenstein DR, Carr-Locke DL. Endoscopic palliation for unresectable pancreatic carcinoma. Surg Clin North Am 1995; 75: 969–989.PubMedGoogle Scholar
  46. 44.
    Sarr MG, Cameron JL. Surgical palliation of unresectable carcinoma of the pancreas. World J Surg 1984; 8: 906–918.PubMedCrossRefGoogle Scholar
  47. 45.
    Rhodes M, Nathanson L, Fielding G. Laparoscopic biliary and gastric bypass: a useful adjunct in the treatment of carcinoma of the pancreas. Gut 1995; 36: 778–780.PubMedCrossRefGoogle Scholar
  48. 46.
    Doberneck RC, Berndt GA. Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg 1987; 122: 827–829.PubMedCrossRefGoogle Scholar
  49. 47.
    Luque-de Leon E, Tsiotos GG, Balsinger B, et al. Staging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate. J Gastrointest Surg 1999; 3: 111–118.CrossRefGoogle Scholar
  50. 48.
    Sohn TA, Lillemoe KD, Cameron JL, et al. Surgical palliation of unresectable periampullary adenocarcinoma in the 1990s. J Am Coll Surg 1999; 188: 655–669.CrossRefGoogle Scholar
  51. 49.
    Espat NJ, Brennan MF, Conlon KC. Patients with laparoscopically staged unresectable pancreatic adenocarcinoma do not require subsequent surgical biliary or gastric bypass. J Am Coll Surg 1999; 188: 649–657.PubMedCrossRefGoogle Scholar
  52. 50.
    Hugier M, Mason NP. Treatment of cancer of the exocrine pancreas. AmJ Surg 1999; 177: 257–265.CrossRefGoogle Scholar
  53. 51.
    Park A, Schwartz R, Tandan V, et al. Laparoscopic pancreatic surgery. Am J Surg 1999; 177: 158–163.PubMedCrossRefGoogle Scholar
  54. 52.
    Kozarek RA, Ball TJ, Patterson DJ. Metallic self-expanding stent applications in the upper gastrointestinal tract: caveats and concerns. Gastrointest Endosc 1992; 38: 1–6.PubMedCrossRefGoogle Scholar
  55. 53.
    Feretis C, Benakis P, Dimopoulos C, et al. Duodenal obstruction caused by pancreatic head carcinoma: palliation with self-expandable prostheses. Gastrointest Endosc 1997; 46: 161–165.PubMedCrossRefGoogle Scholar
  56. 54.
    Keymling M, Wagner HJ, Vakil N, et al. Relief of malignant duodenal obstruction by percutaneous insertion of a metal stent. Am J Gastroenterol 1993; 39: 439–441.Google Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Adrian Park
  • D. W. Birch

There are no affiliations available

Personalised recommendations