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Pancreatic Cancer pp 857–873Cite as

Palliative Surgery in Advanced Pancreatic Cancer

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Abstract

In patients with pancreatic cancer, a high percentage is not eligible for curative treatment, and therefore palliative care is indicated. Malignant obstructive jaundice, severe pain, and gastric outlet obstruction (GOO) contribute a major compromise to patients’ quality of life. To manage these symptoms, different strategies of treatment, either surgical or interventional, are available.

Obstructive jaundice can either be treated by hepatico-/choledochojejunostomy or by interventional placement of a biliary stent. Patency of surgical bypasses by hepaticojejunostomy is longer, when compared to interventionally placed biliary stents. However, self-expandable metal stents (SEMS) display better patency rates, expanding the spectrum of biliary stenting also on patients with longer life expectancy.

GOO significantly contributes to decreased quality of life (QOL). Patients with an unresectable pancreatic cancer at exploration should receive a gastrojejunostomy. Surgical palliation for GOO should be considered due to superiority to interventional duodenal stenting if life expectancy is longer than 2 months.

Pain can sufficiently be treated with neurolytic interventions. Splanchnicectomy provides more sufficient pain relief than neurolysis of the celiac plexus. Prior to neurolytic interventions, a sufficient pharmacological analgesic treatment should be undertaken, and neurolysis should be performed early during workup if irresectability is evident.

In light of potent neoadjuvant treatment regimens, today’s resection polices are getting more aggressive, and exploration should be performed whenever possible. If irresectability is evident during operation, R2 resections should be avoided due to increased postoperative complications and no survival benefit. In these situations, a double bypass surgery is always a better option.

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Author information

Authors and Affiliations

  1. Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, 81675, Munich, Germany

    Florian Scheufele & Helmut Friess

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  1. Florian Scheufele
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  2. Helmut Friess
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Correspondence to Helmut Friess .

Editor information

Editors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    John P. Neoptolemos

  2. Division of Research Department of Surgery and Genomic Sciences and Precision Medicine Center (GSPMC), Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Raul Urrutia

  3. Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA

    James L. Abbruzzese

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Markus W. Büchler

Section Editor information

  1. Duke University Medical Center, Durham, NC, USA

    James L. Abbruzzese

  2. Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Raul A. Urrutia

  3. Division of Surgery and Oncology, University of Liverpool, Daulby Street, Liverpool, UK

    John Neoptolemos

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler

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Scheufele, F., Friess, H. (2018). Palliative Surgery in Advanced Pancreatic Cancer. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7193-0_81

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