Palliation: Surgical and otherwise

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Abstract
Carcinoma of the pancreas remains a disease with a grim prognosis. The majority of patients are not resectable for cure at the time of presentation, with less than 20% of affected patients surviving 1 year after diagnosis. Because cure is unlikely for most patients, palliation of symptoms (obstructive jaundice, duodenal obstruction, and pain) is of primary importance. Obstructive jaundice is the most common presenting symptom for cancer of the pancreas and can be managed by both surgical and nonoperative techniques. Although prospective randomized studies support an early advantage to the nonoperative techniques, concern for late complications, including recurrent jaundice and duodenal obstruction, favor a surgical approach. The management of pain due to unresectable carcinoma of the pancreas remains a significant problem. A recent prospective randomized study has shown that intraoperative chemical splanchnicectomy with 50% alcohol significantly relieves or prevents pain when compared with a placebo treatment. For patients not undergoing surgery, a percutaneous celiac nerve block can be performed quickly with overall good results. The decision to perform nonoperative versus surgical palliation for pancreatic cancer is influenced by the patient's symptoms, overall health status, projected survival, and the expected procedure-related morbidity and mortality. The major advantage for surgical palliation is the ability of a single procedure to combine adequate long term palliation for all three primary symptoms of the disease. Most surgical series report acceptable hospital morbidity and mortality, and a reasonable postoperative length of hospital stay.