Palliative Surgery in Advanced Pancreatic Cancer

  • Dirk J. Gouma
  • O. R. C. Busch
  • T. M. van Gulik
Reference work entry


Although new treatment modalities for pancreatic cancer are being developed continuously, survival remains poor. Symptoms in patients with pancreatic cancer develop late in the course of the disease, about 80% of patients are not eligible for treatment with a curative intention and will need palliative treatment. Most common symptoms that have to be palliated are obstructive jaundice, gastric outlet obstruction and pain.

To palliate obstructive jaundice, a biliary bypass should be performed for the relatively fit patients. Compared to endoscopic biliary stenting, a biliary bypass provides optimal long-term prevention of biliary obstruction, but is associated with higher initial morbidity. Stents are preferred in patients with a relative short survival (<6 months).

Surgical drainage is preferable performed by a hepatico (choledocho) jejunostomy or by (laparoscopic) cholecystojejunostomy.

In addition to the biliary bypass, a gastric bypass should be performed routinely to prevent gastric outlet obstruction due to tumor ingrowth or compression of the duodenum. Novel techniques for palliation of gastric outlet obstruction are being developed, such as endoscopic duodenal stenting and laparoscopic gastroenterostomy. These techniques however, still have to be validated in controlled trials.

More than 90% of patients will have to deal with severe pain during the course of the disease. The initial treatment can be analgesic, but when the disease progresses this will not always be sufficient. A neurolytic celiac plexus block can be performed percutaneously or during laparotomy. A short course of radiotherapy can also be applied to treat pain.

Palliative resection is generally accepted as a R1 resection in patients with questionable extensive local disease during imaging, but data for R2 palliative resection as well as resection in patients with liver metastases, are limited and no clear advantages have been shown so far, but the R2 resection in these circumstances was associated with increased mortality and morbidity.


Pancreatic Cancer Obstructive Jaundice Gastric Outlet Obstruction Palliative Resection Gastric Outlet Obstruction 
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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Dirk J. Gouma
    • 1
  • O. R. C. Busch
    • 1
  • T. M. van Gulik
    • 1
  1. 1.Department of SurgeryAcademic Medical Center from the University of AmsterdamAmsterdamThe Netherlands

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