Surgical palliation of unresectable carcinoma of the pancreas

The results of palliative surgery for pancreatic carcinoma were reviewed in over 10,000 patients from the English-language literature from 1965 to 1983. This collected series suggests that biliary-enteric bypass relieves the sequelae of chronic extrahepatic biliary obstruction, prolongs survival, and provides symptomatic palliation. The more easily constructed loop cholecystojejunostomy is preferred over choledochojejunostomy unless malignant obstruction of the cystic duct is imminent. Chronic percutaneous internal biliary drainage offers reasonable palliation in the poor-risk patient who is not a candidate for surgery. Routine concomitant gastroenterostomy is recommended in all patients with a reasonable life expectancy since operative mortality is unaffected, and the incidence of future duodenal obstruction is at least 16%. Intraoperative chemical splanchnicectomy is easily performed and appears beneficial in relief of pain related to advanced pancreatic carcinoma.