Details

Autor(en) / Beteiligte

• Weitz, Jürgen
• Pausch, Thomas
• Michalski, Christoph W
• Hackert, Thilo
• Hruban, Ralph H
• Beger, Hans G
• Büchler, Markus W
• Neoptolemos, John P
• Shimosegawa, Tooru
• Whitcomb, David C
• Lerch, Markus M
• Groß, Christiane
• Warshaw, Andrew L

Titel

Bypass Surgery for Advanced Pancreatic Cancer

Ist Teil von

• The Pancreas, 2018, p.828-834

Ort / Verlag

Chichester, UK: John Wiley & Sons, Ltd

Erscheinungsjahr

2018

Quelle

Wiley Online Library All Obooks

Beschreibungen/Notizen

• Complete surgical removal is the only curative therapy for pancreatic cancer; however, fewer than 20% of patients present with resectable disease at the time of diagnosis. Among them, less than 10% receive a margin‐negative resection (according to the latest pathology standards) and overall 5‐year survival rates remain at less than 5%. Palliative therapy to reduce or to prevent symptoms is needed in many patients not eligible for resectional surgery. In contrast to a potentially resectable tumor, histologic confirmation should be obtained in potentially palliative cases in order to guide further management. Palliative therapy primarily aims to reduce pain, obstructive jaundice, and duodenal obstruction. The latter two are most frequently palliated using endoscopic/interventional methods, but can also be treated with bypass surgery. However, the potential benefit of a surgical procedure must be weighed carefully against perioperative morbidity and length of hospital stay. This holds particularly true for patients with a presumed very limited overall survival. The decision to perform a surgical bypass procedure is made either in patients in whom the tumor was initially deemed resectable, or in those where endoscopic/interventional bypass is impossible, or in select cases with a potentially relatively good prognosis (e.g. over 1 year of expected survival). This chapter thus focuses on the indications for endoscopic/interventional versus surgical bypass procedures and the respective operative techniques and approaches.