Laparoscopic hepaticojejunostomy and gastrojejunostomy for palliative treatment of pancreatic head cancer in 48 patients.

INTRODUCTION

Approximately 80% of patients with pancreatic cancer are not candidates for curative resection at the time of diagnosis. The objective of this study is to show that although endoscopic treatment is the standard palliation, surgical laparoscopic treatment is both feasible and effective for these patients.

MATERIALS AND METHODS

Preoperative resectability was evaluated by dynamic contrast-enhanced computed tomography scans. Endoscopic palliation was the first choice for patients with metastatic disease and for patients with locally advanced pancreatic cancer with bad performance status. Laparoscopic surgical palliation was indicated for patients with jaundice and locally advanced pancreatic cancer (elective palliation) and for patients with jaundice with metastatic disease and failure in the endoscopic/percutaneous treatment (necessary palliation). Elective palliation consisted of Roux-en-Y hepaticojejunostomy and gastrojejunostomy and necessary palliation consisted of laparoscopic hepaticojejunostomy alone.

RESULTS

A total of 48 patients received laparoscopic surgical palliation. Morbidity rate was 33.3% and mortality was 2.08%. There was no need for late surgeries in any of the patients.

CONCLUSION

Surgical laparoscopic palliation is a feasible treatment option for locally advanced pancreatic cancer. Even though metallic stents are still the best palliation method for patients with systemic disease, if stents fail, the laparoscopic approach is a viable treatment.