[Evaluation of palliative surgical procedures in tumors of the pancreatic head].

Authors studied 87 patients with obstructive jaundice secondary to unresectable cancer of the head of the pancreas undergoing palliative biliary bypass procedure. They compared the four different types of biliodigestive anastomoses regarding to the postoperative morbidity, the mortality, the late complications and the survival. Their data suggest that Roux-en-Y choledochojejunostomy with prophylactic GEA is the optimal palliation. They studied the incidence of a second operation for duodenal obstruction. Comparing the operative mortality of each group they suggest that prophylactic gastroenterostomy adds no risk to patients, but they advise it's routine use only with choledochoenteric bypass and in lack of distant metastasis. Survival was significantly higher (p = 0.015) in the group of patients above 70 years. This data support the slower progression of the pancreatic tumor in old-age. They analyse three different factors affecting operative mortality. It was not related to the depth of jaundice and the age of the patients, but it was in a very close correlation with the preoperative blood urea nitrogen level. Authors suppose this parameter a simply and useful criteria in the selection for non-operative palliative procedures.