Choledochoduodenostomy for palliation in unresectable pancreatic cancer.

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Abstract
PANCREATIC adenocarcinoma is one of the leading causes of cancer death in the United States, and was responsible for an estimated 27000 new cases and 28000 deaths in 1997.1 Unfortunately, most patients have unresectable disease at the time of diagnosis, and in this subset of patients, relief of biliary obstruction becomes the focus of therapeutic intervention. The recent introduction of dynamic spiral computed tomography has aided in identifying patients who have unresectable disease; preferably, these patients should undergo endoscopic stent placement. However, a significant number of patients initially felt to have operable tumors are still found to have unresectable disease at exploration. Additionally, some patients are unable to be stented or have poorly functioning stents that fail to relieve the biliary obstruction. In both these sets of patients, operative biliary bypass must be undertaken.

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