Current role of palliative interventions in advanced pancreatic cancer
Current role of palliative interventions in advanced pancreatic cancer作者机构：Department of Surgical Oncology Warren Alpert Medical School Brown University
出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)
年 卷 期：2018年第10卷第7期
页 面：75-83页
核心收录：
主 题：Surgical palliation Duodenal obstruction Hepatojejunostomy Gastrojejunostomy Endoscopic stenting Malignant ascites Celiac block Palliative triangle Pancreatic cancer Obstructive jaundice
摘 要：Pancreatic adenocarcinoma is the third leading cause of cancer death in the United States. Unfortunately, at diagnosis, most patients are not candidates for curative resection. Surgical palliation, a procedure performed with the intention of relieving symptoms or improving quality of life, comes to the forefront of management. This article reviews the palliative management of unresectable pancreatic cancer, including obstructive jaundice, duodenal obstruction and pain control with celiac plexus block. Although surgical bypasses for both biliary and duodenal obstructions usually achieve good technical success, they result in considerable perioperative morbidity and mortality, even when performed laparoscopically. The effectiveness of selfexpanding metal stents for biliary drainage is excellent with low morbidity. Surgical gastrojejunostomy for duodenal obstruction appears to be best for patients with a life expectancy of greater than 2 mo while endoscopic stenting has been shown to be feasible with good symptom relief in those with a shorter life expectancy. Regardless of the palliative procedure performed, all physicians involved must be adequately trained in end of life management to ensure the best possible care for patients.
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