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Pancreas

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Palliative Surgery

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Abstract

About 80 % of newly diagnosed patients with pancreatic adenocarcinoma cannot benefit from a curative strategy. Palliative approaches of unresectable pancreatic cancer should be adjusted to the expected survival with the aim of preserving the quality of life of these patients. When the diagnosis of unresectable disease is made, nonsurgical endoscopic approaches should be prioritized in order to keep hospital stay as short as possible without delaying systemic chemotherapy. If an unresectable disease is diagnosed at laparotomy, an appropriate palliative surgical treatment should be considered to prevent biliary and enteral obstruction, as well as pain exacerbation due to tumour invasion. Surgical bypass procedures allow significantly more lasting palliation than endoscopic procedures in distinct situations. Since morbidity and mortality of pancreatoduodenectomy have significantly decreased in the last decades, a more aggressive approach towards palliative resection could be justified in specific circumstances. Pain control should not be neglected and is optimized when pharmacotherapy and chemical neurolysis are associated. Since palliative treatment of unresectable pancreatic cancer is not trivial, the choice of the best approach should be discussed by a multidisciplinary team including surgeons, gastroenterologists, radiologists, oncologists and physicians in charge of palliative care.

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Abbreviations

CCD:

Cholecystoduodenostomy

CCJ:

Cholecystojejunostomy

CDD:

Choledochoduodenostomy

CDJ:

Choledochojejunostomy

CT:

Computed tomography

GOO:

Gastric outlet obstruction

RCT:

Randomized controlled trial

RFA:

Radiofrequency ablation

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Authors and Affiliations

  1. Department of Surgery, Swiss Hepato-Pancreato-Biliary Center, University Hospital Zurich, Zurich, 8091, Switzerland

    Andrea Wirsching MD, Mickaël Lesurtel MD, PhD & Pierre-Alain Clavien MD, PhD, FACS, FRCS

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  1. Andrea Wirsching MD
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  2. Mickaël Lesurtel MD, PhD
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  3. Pierre-Alain Clavien MD, PhD, FACS, FRCS
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Correspondence to Mickaël Lesurtel MD, PhD .

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Editors and Affiliations

  1. Department of General Surgery, Mount Gambier General Hospital, Flinders University—Rural Medical School, Mount Gambier, South Australia, Australia

    Matthias W. Wichmann

  2. Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Woodville, South Australia, Australia

    Guy Maddern

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Wirsching, A., Lesurtel, M., Clavien, PA. (2014). Pancreas. In: Wichmann, M., Maddern, G. (eds) Palliative Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-53709-7_12

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