Patients with laparoscopically staged unresectable pancreatic adenocarcinoma do not require subsequent surgical biliary or gastric bypass Journal Article


Authors: Espat, N. J.; Brennan, M. F.; Conlon, K. C.
Article Title: Patients with laparoscopically staged unresectable pancreatic adenocarcinoma do not require subsequent surgical biliary or gastric bypass
Abstract: Background: Laparoscopic staging is an effective and accurate means of staging pancreatic cancer. But, the frequency of subsequent surgical bypass to treat biliary or gastric obstruction in laparoscopically staged patients with unresectable adenocarcinoma is unknown. The development of biliary and gastric obstruction in patients with unresectable pancreatic adenocarcinoma has been reported to occur in as many as 70% and 25% of patients, respectively. Previously, staging for patients with pancreatic cancer was achieved by laparotomy and the anticipated high rate for these patients to develop obstruction led to prophylactic bypass procedures. As laparoscopic staging for pancreatic cancer becomes a standard modality, the need for prophylactic bypass procedures in these patients needs to be examined. Study Design: Analyses of laparoscopically staged patients (n = 155) with unresectable, histologically proved pancreatic adenocarcinoma, from a single institution treated between 1993-1997 were performed. The frequency of surgical bypass in a prospective cohort of patients with unresectable pancreatic adenocarcinoma who did not undergo open enteric or biliary bypass at the time of laparoscopic staging was determined. Results: Laparoscopic staging revealed that 40 patients had locally advanced disease and 115 had metastatic disease. Median survival for patients with locally advanced and metastatic disease was 6.2 and 7.8 months, respectively. Postlaparoscopy follow-up revealed that 98% (152 of 155) of these patients did not require a subsequent open surgical procedure to treat biliary or gastric obstruction. Conclusions: These results do not support the practice of routine prophylactic bypass procedures. As such, we propose that surgical biliary bypass can be advocated only for those patients with obstructive jaundice who fail endoscopic stent placement, and gastroenterostomy should be reserved for patients with confirmed gastric outlet obstruction.
Keywords: adult; aged; aged, 80 and over; middle aged; survival rate; pancreatic neoplasms; cancer staging; neoplasm staging; laparoscopy; prospective studies; adenocarcinoma; palliative care; postoperative complication; bilirubin; survival time; pancreas adenocarcinoma; symptomatology; bile duct obstruction; biliary tract surgical procedures; bilirubin blood level; cholestasis; stents; gastric outlet obstruction; stomach obstruction; gastroenterostomy; obstructive jaundice; stomach bypass; bile duct bypass; humans; human; male; female; priority journal; article
Journal Title: Journal of the American College of Surgeons
Volume: 188
Issue: 6
ISSN: 1072-7515
Publisher: Elsevier Science, Inc.  
Date Published: 1999-06-01
Start Page: 649
End Page: 657
Language: English
DOI: 10.1016/s1072-7515(99)00050-2
PUBMED: 10359358
PROVIDER: scopus
DOI/URL:
Notes: Article -- Export Date: 16 August 2016 -- Source: Scopus
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MSK Authors
  1. Murray F Brennan
    755 Brennan
  2. Nocif Joseph Espat
    11 Espat
  3. Kevin C Conlon
    112 Conlon