Role of preoperative palliation of jaundice in pancreatic cancer View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2013-04-18

AUTHORS

Richard Kozarek

ABSTRACT

Background/purposeRecent studies suggest that there is no significant benefit and that there may be significantly higher morbidity rates in pancreatic cancer patients who undergo preoperative plastic stent placement for obstructive jaundice. This review attempts to define the role of stenting in patients with pancreatic cancer and malignant obstructive jaundice. The latter includes patients unresectable for cure, those who are too frail to withstand an operation, the occasional patient who presents with cholangitis, and those patients who will have a significant delay in surgery because of preoperative neoadjuvant therapy.MethodsLiterature review. A therapeutic endoscopy team member of a multidisciplinary team which evaluates and treats >250 pancreatic cancer patients yearly.ResultsThere are 5 historical randomized controlled trials (RCTs) and 1 current RCT demonstrating no significant benefit in preoperatively decompressing jaundiced patients with pancreatic malignancy with percutaneously placed tubes or endoscopically inserted plastic stents. There are 5 RCTs defining a longer patency rate with self-expandable metal stents (SEMS) compared to plastic prostheses suggesting that in the setting of palliation as well as the use of neoadjuvant therapy for resectable or borderline resectable patients, SEMS placement is preferable.ConclusionsDespite data demonstrating lack of efficacy and potential harm in decompressing the biliary tree as opposed to early surgery in jaundiced patients with pancreatic malignancy, endoscopic retrograde cholangiopancreatography with SEMS insertion remains an invaluable palliative modality in non-resectable patients as well as those in whom contemplated resection is delayed in order to give neoadjuvant therapy. More... »

PAGES

567-572

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00534-013-0612-4

DOI

http://dx.doi.org/10.1007/s00534-013-0612-4

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1028418033

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/23595581


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