Nonoperative Versus Operative Treatment of Obstructive Jaundice in Unresectable Pancreatic Cancer

ABSTRACT

Despite advances in diagnostic technology, pancreatic carcinoma is usually unresectable at the time of operation. The most common problem facing the surgeon today is determining the best method of palliation for biliary obstruction. The objectives of this study were to identify the role of nonoperative treatment for obstructive jaundice in pancreatic cancer and to compare the recurrence and survival period of operative and nonoperative treatment group. During the period of September 1987 to February 1995, a operative or nonoperative treatment was performed in 65 patients with obstructive jaundice in pancreatic carcinoma, at the Department of Surgery, Korea University, College of Medicine. We classified the patients into pancreatic resection(n=12), operative bypass(n=22), and nonoperative biliary bypass(n=31) groups according to the procedure performed. And we separated the nonoperative biliary bypass into endoscopic(n=10) and percutaneous drainage(n=21) groups. There were no significant differences with respect to the mortality within the 1st month and admission period. The type of procedure had influence on the survival of 78.3%, 57.1%, and 48.1% for resection, operative bypass and nonoperative biliary bypass, respectively. During follow-up, the difference was found with respect to the recurrence of jaundice and the morbidity within the 1st month. In conclusion, in patients with unresectable pancreatic cancer, surgical bypass procedure would be more efficient for relief of biliary obstruction than nonoperative biliary drainage. Nonoperative biliary drainage for obstructive jaundice of pancreatic cancer should be used only when the patient was not a candidate for operation.