Prospective Controlled Trial of Transhepatic Biliary Endoprosthesis Versus Bypass Surgery for Incurable Carcinoma of Head of Pancreas

Bornman, PhilippusC.; Tobias, R; Harries-Jones, E.P.; Stiegmann, GregoryVan; Terblanche, J.

doi:10.1016/s0140-6736(86)90719-1

Cited by 213 publications

(73 citation statements)

References 8 publications

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“…However, recurrence of jaundice with or without cholangitis is more frequently reported after the use of stents. Four prospective randomized trials have shown that recurrent jaundice/cholangitis was more frequent after stenting (up to 38%) than after bypass surgery (3-10%) [23][24][25][26]. Whether these short periods of recurrent jaundice/cholangitis and subsequent stent changes have any effects on the quality of life of these patients remains to be analyzed.…”

Section: Jaundicementioning

confidence: 99%

“…Reviews from the literature have shown that late duodenal obstruction occurs in 0% to 20% of patients after endoscopic palliation and in around 17% after a surgical bypass without a (prophylactic) gastrojejunostomy [23][24][25][26][27]. In a consecutive series of 691 patients treated by endoscopic stenting in our Department of Gastroenterology (AMC), the overall incidence of duodenal obstruction until death was 11%; 9% in patients with a pancreatic carcinoma, 14% for patients with bile duct carcinoma, and 23% for patients with an ampullary tumor [28].…”

Section: Gastrointestinal or Duodenal Obstructionmentioning

confidence: 99%

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Are There Indications for Palliative Resection in Pancreatic Cancer?

et al. 1999

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Section: Jaundicementioning

confidence: 99%

Section: Gastrointestinal or Duodenal Obstructionmentioning

confidence: 99%

Are There Indications for Palliative Resection in Pancreatic Cancer?

et al. 1999

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“…Contrariwise to prospective studies performed by Bornmann et al [15], Shepherd et al [21], and Smith et al [4], which showed that patients who had undergone endoscopic stent placement seemed to have a survival benefit compared to surgical patients (Table 4). This controversy in the results may be explained by the selected patients in surgery group, as most of these patients were thought to have a resectable tumor after conventional radiological staging.…”

Section: Discussionmentioning

confidence: 88%

Surgical Bypass versus Endoscopic Stenting for Unresectable Head Pancreatic Cancer, Which Palliative Treatment Is Better in Developing Countries, Morocco as an Example

Mazine¹,

Mohammed²,

Karima³

et al. 2017

OJGas

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Background: Metal stents for unresectable pancreatic cancer are associated with longer patency and superior cost-effectiveness. However, they are too expensive to be recommended routinely in developing countries. Moreover, a debate on outcome results in these patients who receive plastic biliary endoprothesis versus surgical bypass as palliation of obstructive jaundice. We aimed to compare retrospectively the outcomes in patients treated with plastic stent or surgical bypass as a palliative option for these patients. Patients and Methods: We have examined data for patients (n = 86) who received endoscopic stenting (n = 64) or surgical bypass (n = 22), from January 2013 to November 2016, as a palliative treatment for obstructive jaundice from inoperable cancer head pancreas. Results: Serum bilirubin and CA19.9 levels were comparable in age and gender matched patient groups. Moreover, post-operative major complications and 30-days mortality showed no significant differences among patient groups. However, surgical bypass treated patients showed longer initial hospital stay (9 vs. 6 days, p = 0.014), higher cost ($1600 vs. $1088) and longer survival (192 vs. 101 days, p = 0.003) compared to endoscopy-stenting treated patients. Re-hospitalization was required for 5 stented patients (averaged $448). Conclusion: Biliary bypass surgery for unresectable pancreatic cancer may improve patient survival, although prolongs hospital stay. It may be recommended for relatively fit patients with a life expectancy of 6 months and more.

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“…Significant advances have been made in non-operative palliation for periampullary cancer. Percutaneous or endoscopic palliation of obstructive jaundice can provide biliary decompression with lower early morbidity compared to open biliary bypass surgery [15][16][17][18] . However, these techniques have had disappointing outcomes with regard to recurrent jaundice.…”

Section: Discussionmentioning

confidence: 99%

Surgical palliation of unresectable pancreatic head cancer in elderly patients

Hwang¹,

Kim²,

Son³

et al. 2009

WJG

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AIM:To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS:Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS:Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively).The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION:Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

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Prospective Controlled Trial of Transhepatic Biliary Endoprosthesis Versus Bypass Surgery for Incurable Carcinoma of Head of Pancreas

Cited by 213 publications

References 8 publications

Are There Indications for Palliative Resection in Pancreatic Cancer?

Are There Indications for Palliative Resection in Pancreatic Cancer?

Surgical Bypass versus Endoscopic Stenting for Unresectable Head Pancreatic Cancer, Which Palliative Treatment Is Better in Developing Countries, Morocco as an Example

Surgical palliation of unresectable pancreatic head cancer in elderly patients

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