Palliative Surgical Therapy: Palliative Bypass Procedure

Abstract

Pancreatic carcinoma (PC) is a highly malignant cancer featured by very poor prognosis. Radical surgical resection is the most curative way at present. However, owing to lack of symptoms at early stage and rapid progression, 80% of patients are considered not amenable to surgical resection because of locally advanced or metastatic condition when diagnosed. Up to a third of the remaining 20% of patients eligible for surgical exploration before operation are found to be unresectable during operation [1]. Unfortunately, most of patients are not amenable to toxic and side effects of radiotherapy or chemotherapy drug either. In addition, the sensitivity of pancreatic cancer cells to chemotherapy drug is very poor. So generally, therapeutic outcome of pancreatic cancer is dismal. What is worse, patients with PC often present with malignant obstructive jaundice and duodenal obstruction, the rate of incidence of which is 75% and 20%, respectively [1]. Jaundice would cause pruritus, nausea, coagulopathy, and, most severely, hepatorenal dysfunction and endotoxemia, which may directly lead to the death of patients. Duodenal obstruction leads to malnourishment and intractable vomiting [2]. Both obstructions negatively affect quality of life and prognosis. Therefore, aside from improving effectiveness of curative treatment to prolong survival, palliative treatment to relieve pain and improve quality of life is another significant aspect of treatment for patients with unresectable pancreatic carcinoma.