Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1990 Aug;212(2):132–139. doi: 10.1097/00000658-199008000-00003

Surgical palliation for pancreatic cancer. The UCLA experience.

S M Singh 1, W P Longmire Jr 1, H A Reber 1
PMCID: PMC1358046  PMID: 1695834

Abstract

We reviewed the records of 340 patients with a tissue diagnosis of pancreatic cancer treated at UCLA Medical Center between 1973 and 1988. Sixty-one patients underwent pancreatic resection (group I), 173 had some form of surgical palliation (group II), and 106 had neither (group III). The diagnosis was made 1 to 2 months more quickly in the last 8 years of the review than in the first 8 years, but the effect of early diagnosis on curability was negligible. Biliary obstruction was best treated by cholecystojejunostomy or choledochojejunostomy, which were equally effective. Anastomoses to the jejunum were safer and more effective than were those to the duodenum for the relief of biliary obstruction. Gastrojejunostomy should be performed prophylactically as well as therapeutically. It was effective and safe in both settings. Surgical palliation for pancreatic cancer was generally effective and was associated with an operative mortality rate of less than 10%. However morbidity was high, with significant complications occurring in one third of cases.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Andersson A., Bergdahl L. Carcinoma of the pancreas. Am Surg. 1976 Mar;42(3):173–177. [PubMed] [Google Scholar]
  2. Aston S. J., Longmire W. P., Jr Pancreaticoduodenal resection. Twenty years' experience. Arch Surg. 1973 Jun;106(6):813–817. doi: 10.1001/archsurg.1973.01350180047015. [DOI] [PubMed] [Google Scholar]
  3. Baker R. R., Pio Roda C. L., Lee J. M. Carcinoma of the head of the pancreas and periampullary region. Johns Hopkins Med J. 1973 Apr;132(4):212–221. [PubMed] [Google Scholar]
  4. Beall M. S., Dyer G. A., Stephenson H. E., Jr Disappointments in the management of patients with malignancy of pancreas, duodenum, and common bile duct. Arch Surg. 1970 Oct;101(4):461–465. doi: 10.1001/archsurg.1970.01340280013004. [DOI] [PubMed] [Google Scholar]
  5. Blievernicht S. W., Neifeld J. P., Terz J. J., Lawrence W., Jr The role of prophylactic gastrojejunostomy for unresectable periampullary carcinoma. Surg Gynecol Obstet. 1980 Dec;151(6):794–796. [PubMed] [Google Scholar]
  6. Brooks J. R., Culebras J. M. Cancer of the pancreas. Palliative operation, Whipple procedure, or total pancreatectomy? Am J Surg. 1976 Apr;131(4):516–520. doi: 10.1016/0002-9610(76)90167-7. [DOI] [PubMed] [Google Scholar]
  7. Copping J., Willix R., Kraft R. Palliative chemical splanchnicectomy. Arch Surg. 1969 Apr;98(4):418–420. doi: 10.1001/archsurg.1969.01340100050004. [DOI] [PubMed] [Google Scholar]
  8. DE TAKATS G., WALTER L. E., LASNER J. Splanchnic nerve section for pancreatic pain; second report. Ann Surg. 1950 Jan;131(1):44-57, illust. doi: 10.1097/00000658-195001000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Deschamps G., Bourbeau D. Pancreatic carcinoma: surgical treatment. Can J Surg. 1984 Nov;27(6):559–560. [PubMed] [Google Scholar]
  10. Doberneck R. C., Berndt G. A. Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg. 1987 Jul;122(7):827–829. doi: 10.1001/archsurg.1987.01400190093020. [DOI] [PubMed] [Google Scholar]
  11. Flanigan D. P., Kraft R. O. Continuing experience with palliative chemical splanchnicectomy. Arch Surg. 1978 Apr;113(4):509–511. doi: 10.1001/archsurg.1978.01370160167029. [DOI] [PubMed] [Google Scholar]
  12. GLENN F., THORBJARNARSON B. CARCINOMA OF THE PANCREAS. Ann Surg. 1964 Jun;159:945–958. doi: 10.1097/00000658-196406000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Gallitano A., Fransen H., Martin R. G. Carcinoma of the pancreas. Results of treatment. Cancer. 1968 Nov;22(5):939–944. doi: 10.1002/1097-0142(196811)22:5<939::aid-cncr2820220507>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  14. Gordis L., Gold E. B. Epidemiology of pancreatic cancer. World J Surg. 1984 Dec;8(6):808–821. doi: 10.1007/BF01656020. [DOI] [PubMed] [Google Scholar]
  15. Howard J. M., Jordan G. L., Jr Cancer of the pancreas. Curr Probl Cancer. 1977 Sep;2(3):5–52. doi: 10.1016/s0147-0272(77)80001-9. [DOI] [PubMed] [Google Scholar]
  16. Krain L. S. The rising incidence of cancer of the pancreas--further epidemiologic studies. J Chronic Dis. 1971 Mar;23(10):685–690. doi: 10.1016/0021-9681(71)90002-6. [DOI] [PubMed] [Google Scholar]
  17. Malangoni M. A., McCoy D. M., Richardson J. D., Flint L. M. Effective palliation of malignant biliary duct obstruction. Ann Surg. 1985 May;201(5):554–559. doi: 10.1097/00000658-198505000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Mongé J. J. Survival of patients with small carcinomas of the head of the pancreas. Biliary-intestinal bypass vs. pancreatoduodenectomy. Ann Surg. 1967 Dec;166(6):908–912. doi: 10.1097/00000658-196712000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. NELSON E. R., BIERMAN H. R. DENGUE FEVER: A THROMBOCYTOPENIC DISEASE? JAMA. 1964 Oct 12;190:99–103. doi: 10.1001/jama.1964.03070150009002. [DOI] [PubMed] [Google Scholar]
  20. Potts J. R., 3rd, Broughan T. A., Hermann R. E. Palliative operations for pancreatic carcinoma. Am J Surg. 1990 Jan;159(1):72–78. doi: 10.1016/s0002-9610(05)80609-9. [DOI] [PubMed] [Google Scholar]
  21. RAY B. S., CONSOLE A. D. The relief of pain in chronic (calcareous) pancreatitis by sympatheotomy. Surg Gynecol Obstet. 1949 Jul;89(1):1–8. [PubMed] [Google Scholar]
  22. Sarr M. G., Cameron J. L. Surgical palliation of unresectable carcinoma of the pancreas. World J Surg. 1984 Dec;8(6):906–918. doi: 10.1007/BF01656032. [DOI] [PubMed] [Google Scholar]
  23. Tanaka T., Kodama M., Seikoh R., Takeuchi H., Itoh N., Kodama O., Ezaki H. Surgical treatment for periampullary carcinoma: a study of 129 patients. Hiroshima J Med Sci. 1984 Jun;33(2):179–183. [PubMed] [Google Scholar]
  24. Trede M. Treatment of pancreatic carcinoma: the surgeon's dilemma. Br J Surg. 1987 Feb;74(2):79–80. doi: 10.1002/bjs.1800740202. [DOI] [PubMed] [Google Scholar]
  25. Warren K. W., Braasch J. W., Thum C. W. Carcinoma of the pancreas. Surg Clin North Am. 1968 Jun;48(3):601–618. doi: 10.1016/s0039-6109(16)38543-7. [DOI] [PubMed] [Google Scholar]
  26. Weaver D. W., Wiencek R. G., Bouwman D. L., Walt A. J. Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery. 1987 Oct;102(4):608–613. [PubMed] [Google Scholar]
  27. YOSHIOKA H., WAKABAYASHI T. Therapeutic neurotomy on head of pancreas for relief of pain due to chronic pancreatitis; a new technical procedure and its results. AMA Arch Surg. 1958 Apr;76(4):546–554. doi: 10.1001/archsurg.1958.01280220066013. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES