Abstract
This debate discusses the palliative management of pancreatic cancer. The arguments in favour of surgical palliation are that this approach allows all symptoms to be treated or prevented, the diagnosis can be confirmed histologically and a final assessment of resectability can be made. The arguments against the use of surgery are that survival is short and that effective alternative therapies are available: endoscopic intubation, percutaneous coeliac plexus block and pancreatic enzyme supplements. The most appropriate policy, however, is to tailor the management plan to suit the individual patient.
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Selected References
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- Allen-Mersh T. G., Earlam R. J. Pancreatic cancer in England and Wales: surgeons look at epidemiology. Ann R Coll Surg Engl. 1986 May;68(3):154–158. [PMC free article] [PubMed] [Google Scholar]
- Andersen J. R., Sørensen S. M., Kruse A., Rokkjaer M., Matzen P. Randomised trial of endoscopic endoprosthesis versus operative bypass in malignant obstructive jaundice. Gut. 1989 Aug;30(8):1132–1135. doi: 10.1136/gut.30.8.1132. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Andrén-Sandberg A., Ihse I. Factors influencing survival after total pancreatectomy in patients with pancreatic cancer. Ann Surg. 1983 Nov;198(5):605–610. doi: 10.1097/00000658-198311000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bornman P. C., Harries-Jones E. P., Tobias R., Van Stiegmann G., Terblanche J. Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas. Lancet. 1986 Jan 11;1(8472):69–71. doi: 10.1016/s0140-6736(86)90719-1. [DOI] [PubMed] [Google Scholar]
- Bradbeer J. W., Johnson C. D. Pancreaticogastrostomy after pancreaticoduodenectomy. Ann R Coll Surg Engl. 1990 Jul;72(4):266–269. [PMC free article] [PubMed] [Google Scholar]
- Cooper M. J., Williamson R. C. Conservative pancreatectomy. Br J Surg. 1985 Oct;72(10):801–803. doi: 10.1002/bjs.1800721009. [DOI] [PubMed] [Google Scholar]
- Cotton P. B. Endoscopic methods for relief of malignant obstructive jaundice. World J Surg. 1984 Dec;8(6):854–861. doi: 10.1007/BF01656025. [DOI] [PubMed] [Google Scholar]
- Devereux D. F., Greco R. S. Biliary enteric bypass for malignant obstruction. Cancer. 1986 Aug 15;58(4):981–984. doi: 10.1002/1097-0142(19860815)58:4<981::aid-cncr2820580431>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
- Dunn E. The impact of technology and improved perioperative management upon survival from carcinoma of the pancreas. Surg Gynecol Obstet. 1987 Mar;164(3):237–244. [PubMed] [Google Scholar]
- Edis A. J., Kiernan P. D., Taylor W. F. Attempted curative resection of ductal carcinoma of the pancreas: review of Mayo Clinic experience, 1951-1975. Mayo Clin Proc. 1980 Sep;55(9):531–536. [PubMed] [Google Scholar]
- Gardner A. M., Solomou G. Relief of the pain of unresectable carcinoma of pancreas by chemical splanchnicectomy during laparotomy. Ann R Coll Surg Engl. 1984 Nov;66(6):409–411. [PMC free article] [PubMed] [Google Scholar]
- Gorbitz C., Leavens M. E. Alcohol block of the celiac plexus for control of upper abdominal pain caused by cancer and pancreatitis. Technical note. J Neurosurg. 1971 Apr;34(4):575–579. doi: 10.3171/jns.1971.34.4.0575. [DOI] [PubMed] [Google Scholar]
- Grace P. A., Pitt H. A., Longmire W. P. Pancreatoduodenectomy with pylorus preservation for adenocarcinoma of the head of the pancreas. Br J Surg. 1986 Aug;73(8):647–650. doi: 10.1002/bjs.1800730824. [DOI] [PubMed] [Google Scholar]
- Gudjonsson B., Livstone E. M., Spiro H. M. Cancer of the pancreas: diagnostic accuracy and survival statistics. Cancer. 1978 Nov;42(5):2494–2506. doi: 10.1002/1097-0142(197811)42:5<2494::aid-cncr2820420554>3.0.co;2-r. [DOI] [PubMed] [Google Scholar]
- Ishikawa O., Ohhigashi H., Sasaki Y., Kabuto T., Fukuda I., Furukawa H., Imaoka S., Iwanaga T. Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg. 1988 Aug;208(2):215–220. doi: 10.1097/00000658-198808000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kairaluoma M. I., Kiviniemi H., Ståhlberg M. Pancreatic resection for carcinoma of the pancreas and the periampullary region in patients over 70 years of age. Br J Surg. 1987 Feb;74(2):116–118. doi: 10.1002/bjs.1800740216. [DOI] [PubMed] [Google Scholar]
- La Ferla G., Murray W. R. Carcinoma of the head of the pancreas: bypass surgery in unresectable disease. Br J Surg. 1987 Mar;74(3):212–213. doi: 10.1002/bjs.1800740321. [DOI] [PubMed] [Google Scholar]
- Leung J. W., Bowen-Wright M., Aveling W., Shorvon P. J., Cotton P. B. Coeliac plexus block for pain in pancreatic cancer and chronic pancreatitis. Br J Surg. 1983 Dec;70(12):730–732. doi: 10.1002/bjs.1800701212. [DOI] [PubMed] [Google Scholar]
- Leung J. W., Emery R., Cotton P. B., Russell R. C., Vallon A. G., Mason R. R. Management of malignant obstructive jaundice at The Middlesex Hospital. Br J Surg. 1983 Oct;70(10):584–586. doi: 10.1002/bjs.1800701006. [DOI] [PubMed] [Google Scholar]
- Moossa A. R. Pancreatic cancer: approach to diagnosis, selection for surgery and choice of operation. Cancer. 1982 Dec 1;50(11 Suppl):2689–2698. [PubMed] [Google Scholar]
- 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]
- Robertson D. A., Ayres R., Hacking C. N., Shepherd H., Birch S., Wright R. Experience with a combined percutaneous and endoscopic approach to stent insertion in malignant obstructive jaundice. Lancet. 1987 Dec 19;2(8573):1449–1452. doi: 10.1016/s0140-6736(87)91141-x. [DOI] [PubMed] [Google Scholar]
- Saltzburg D., Foley K. M. Management of pain in pancreatic cancer. Surg Clin North Am. 1989 Jun;69(3):629–649. doi: 10.1016/s0039-6109(16)44839-5. [DOI] [PubMed] [Google Scholar]
- Sarr M. G., Cameron J. L. Surgical management of unresectable carcinoma of the pancreas. Surgery. 1982 Feb;91(2):123–133. [PubMed] [Google Scholar]
- Sato T., Saitoh Y., Noto N., Matsuno S. Follow-up studies of radical resection for pancreaticoduodenal cancer. Ann Surg. 1977 Nov;186(5):581–588. doi: 10.1097/00000658-197711000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shepherd H. A., Royle G., Ross A. P., Diba A., Arthur M., Colin-Jones D. Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial. Br J Surg. 1988 Dec;75(12):1166–1168. doi: 10.1002/bjs.1800751207. [DOI] [PubMed] [Google Scholar]
- Singh S. M., Reber H. A. Surgical palliation for pancreatic cancer. Surg Clin North Am. 1989 Jun;69(3):599–611. doi: 10.1016/s0039-6109(16)44837-1. [DOI] [PubMed] [Google Scholar]
- Soehendra N., Reynders-Frederix V. Palliative bile duct drainage - a new endoscopic method of introducing a transpapillary drain. Endoscopy. 1980 Jan;12(1):8–11. doi: 10.1055/s-2007-1021702. [DOI] [PubMed] [Google Scholar]
- Speer A. G., Cotton P. B., Russell R. C., Mason R. R., Hatfield A. R., Leung J. W., MacRae K. D., Houghton J., Lennon C. A. Randomised trial of endoscopic versus percutaneous stent insertion in malignant obstructive jaundice. Lancet. 1987 Jul 11;2(8550):57–62. doi: 10.1016/s0140-6736(87)92733-4. [DOI] [PubMed] [Google Scholar]
- Tashiro S., Murata E., Hiraoka T., Nakakuma K., Watanabe E., Miyauchi Y. New technique for pancreaticojejunostomy using a biological adhesive. Br J Surg. 1987 May;74(5):392–394. doi: 10.1002/bjs.1800740523. [DOI] [PubMed] [Google Scholar]
- Trede M. The surgical treatment of pancreatic carcinoma. Surgery. 1985 Jan;97(1):28–35. [PubMed] [Google Scholar]
- van Heerden J. A. Pancreatic resection for carcinoma of the pancreas: Whipple versus total pancreatectomy--an institutional perspective. World J Surg. 1984 Dec;8(6):880–888. doi: 10.1007/BF01656028. [DOI] [PubMed] [Google Scholar]
