Surgical palliation of unresectable pancreatic head cancer in elderly patients

Abstract

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.

Pancreatic Cancer in the Very Elderly Patient: Challenges and Solutions

“…Similar results have been found in a more recent, albeit small retrospective study of 55 elderly patients (over 65 years old). 50 These authors similarly conclude that surgical palliation is superior to endoscopic stenting for malignant biliary obstruction even in spite of any increased surgical risk related to advanced age. They report no difference in morbidity or mortality, but better quality of life and longer survival in open bypass patients (mean 290 compared to 150 days).…”

Continuous Transarterial Infusion Chemotherapy with Gemcitabine and 5-Fluorouracil for Advanced Pancreatic Carcinoma

“…The literature reports regarding chemotherapy of pancreatic carcinoma through peripheral vein mainly concentrate on drug choice and medicine compatibility, and the results differ (Moore et al, 2003;Tomoo et al, 2006;Wilkowski et al, 2006;Ouaissi et al, 2008;Hwang et al, 2009). Because of low regional concentration and low medicine sensibility, the effectiveness of systemic chemotherapy in the treatment of pancreatic carcinoma is dissatisfactory and the adverse reactions are serious in most literatures.…”

“…Unfortunately, the curative effect of advanced pancreatic carcinoma is very poor. Previously used chemotherapy and radiotherapy regiments often can not produce a satisfactory curative effect (Moore et al, 2003;Wilkowski et al, 2006;Ouaissi et al, 2008;Hwang et al, 2009). Under such conditions, it is of great value to develop new alleviative treatment regiments, especially those that can improve the patients'quality of life.…”

“…Chemotherapy is one of the most important therapeutic methods in the treatment of pancreatic carcinoma. However at present, the commonly used chemotherapy still cannot produce a satisfactory clinical curative affect,and the adverse reactions are serious.Under such conditions, it is of great value to develop new alleviative treatment regimens, especially 1 those that can improve the patients,quality of life (Moore et al, 2003;Wilkowski et al, 2006;Ouaissi et al, 2008;Hwang et al, 2009).…”

Nitinol biliary stent versus surgery for palliation of distal malignant biliary obstruction

“…Nevertheless, operative bypass has a low recurrent jaundice rate of 2-5% and provides the opportunity for gastrojejunostomy in patients with duodenal obstruction. Fit patients with unresectable pancreatic cancer complicated by duodenal obstruction and those who have a relatively prolonged life expectancy my benefit more from surgery [19,20].…”