Laparoscopic Biliary and Gastric Bypass

Abstract

In the United States, pancreatic cancer is the fourth leading cause of cancer death in men and the fifth in women (1). It is estimated that, in 1998, 27,600 new cases will be diagnosed, with the majority dying of their disease (2). In spite of some recent progress in diagnosis and treatment, the outlook for the majority of patients remains bleak. Adenocarcinoma accounts for more than 90% of pancreatic tumors, and is a particularly aggressive lesion; at the time of diagnosis, the tumor is confined to the pancreas in fewer than 10% of patients, 40% have locally advanced disease, and over 50% have distant spread (3,4). More than 95% of patients eventually die of their disease, most within the first year (5). Radiation and chemotherapy have been shown to be of only marginal benefit (6,7); the primary mode of therapy continues to be surgical resection (8). However, only 20–25% of patients actually prove to have resectable disease at the time of exploration.