The Role for Palliative Surgical Interventions in Pancreatic Cancer

Abstract

Pancreatic cancer is fraught with complications that drastically affect the quality of life of patients suffering from this devastating disease. Many patients present with biliary obstruction, gastric outlet obstruction, and malignant bowel obstruction secondary to tumor burden and local invasion. While surgery has been utilized liberally to treat these conditions, more recent evidence emphasizing palliation, decreased hospital length of stay, and patient comfort suggests that less invasive interventions such as endoscopic stenting and palliative drainage tubes may serve as a better option for symptom relief. Stenting of the biliary tree or duodenum for biliary obstruction and gastric outlet obstruction, respectively, has been shown to quickly relieve symptoms without significant complications or comorbidities. Likewise, palliative percutaneous endoscopic gastrostomy (PEG) tubes have also proven useful in improving nausea and vomiting in the setting of malignant bowel obstruction. Although some promising developments for treatment of locally advanced disease in the form of irreversible electroporation (IRE) have been proposed, these interventions are still in their early stages of investigation and clinical application. While some may advocate for more aggressive approaches such as liver resection in select patients with liver metastases, or cytoreduction with hyperthermic intraperitoneal chemotherapy (HIPEC) to treat peritoneal disease, consideration for quality of life in patients whose survival is estimated in weeks to months may ultimately favor a “less-is-more” approach.