COMPARISON OF BILIARY STENTING AND SURGICAL BYPASS IN PALLIATIVE MANAGEMENT OF IRRESECTABLE PERIAMPULLARY CARCINOMA
AbstractBackground: Some 20–40% of the periampullary carcinoma is irresectable at the time of diagnosis. Biliary stenting and surgical bypass are commonly used palliative procedure. There is no consensus favouring one procedure over the other. This study compares the both procedures. Methods: This Randomized Controlled Trial included 47 patients who presented with diagnosis of obstructive jaundice due to periampullary carcinoma to the Department of Surgery, Federal General Hospital, Islamabad from July 2012 to December 2014. Results: Out of total 47 patients 27 (57.44%) were males and 20 (42.55%) were females. Group-A included 25 (53.19%) patients while group-B included 22 (46.81%) patients. The mean age in both groups was 62.34 years (SD=±5.01). All patients died during the study. The mean survival time for the stent patients was 7.5 months while the mean survival time for surgical bypass patients was 8.3 months. The jaundice was relived in all surgical (22, 100%) of the patients as compared to (18, 72%) of the patients in stent group. Conclusion: We concluded that surgical bypass as a primary procedure in selected patients provided better jaundice relieve as compared to biliary stenting.Keywords: Periampullary Carcinoma; Biliary Stent; Malignant Jaundice
Siddique K, Ali Q, Mirza S, Jamil A, Ehsan A, Latif S, et al. Evaluation of the aetiological spectrum of obstructive jaundice. J Ayub Med Coll Abbottabad 2008;20(4):62–6.
Watanapa P, Williamson RC. Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg 1992;79(1):8–20.
Distler M, Kersting S, Rückert F, Dobrowolski F, Miehlke S, Grützmann R, et al. Palliative treatment of obstructive jaundice in patients with carcinoma of the pancreatic head or distal biliary tree. Endoscopic stent placement vs. hepaticojejunostomy. JOP 2010;11(6):568–74.
Čečka F, Jon B, Dvořák J, Repák R, Subrt Z, Ferko A. [Palliative surgical treatment of tumors of pancreas and periampullary region]. Klin Onkol 2012;25(2):117–23.
Mari G, Costanzi A, Monzio N, Miranda A, Rigamonti L, Crippa J, et al. Small bowel perforation caused by pancreaticojejunal anastomotic stent migration after pancreaticoduodenectomy for periampullary carcinoma. JOP 2015;16(2):185–8.
Lesurtel M, Dehni N, Tiret E, Parc R, Paye F. Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal. J Gastrointest Surg 2006;10(2):286–91.
Aswad MG, Dennison AR, Neal CP, Metcalfe MS, Garcea G. Biliary stenting for benign and malignant obstructive jaundice: safe use of extended stent-change intervals. Surg Laparosc Endosc Percutan Tech 2014;24(4):385–90.
Nuzzo G, Clemente G, Cadeddu F, Giovannini I. Palliation of unresectable periampullary neoplasms. "surgical" versus "non-surgical" approach. Hepatogastroenterology 2004;51(59):1282–5.
Lan Z, Tang X, Zhang J, Wang C. Clinical significance of preoperative biliary drainage for patients with moderate jaundice: a prospective non-randomized controlled study. Zhonghua Yi Xue Za Zhi 2015;95(2):93–5.
Olsson G, Arnelo U, Lundell L, Persson G, Törnqvist B, Enochsson L. The role of antibiotic prophylaxis in routine endoscopic retrograde cholangiopancreatography investigations as assessed prospectively in a nationwide study cohort. Scand J Gastroenterol 2015;50(7):924–31.
Hatzaras I, George N, Muscarella P, Melvin WS, Ellison EC, Bloomston M. Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann Surg Oncol 2010;17(4):991–7.
Bhatti AB, Yosuf MA, Syed AA. Radical surgical management of periampullary duodenal adenocarcinoma: a single institution experience. J Pak Med Assoc 2014;64(11):1260–4.
Maire F, Hammel P, Ponsot P, Aubert A, O'Toole D, Hentic O, et al. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 2006;101(4):735–42.
Gargouri D, Kochlef A, Ouekaa A, Elloumi H, Kilani A, Romani M, et al. Biliary stent occlusion. Tunis Med 2010;88(7):462–6.
Singh S, Sachdev AK, Chaudhary A, Agarwal AK. Palliative surgical bypass for unresectable periampullary carcinoma. Hepatobiliary Pancreat Dis Int 2008;7(3):308–12.
Glazer ES, Hornbrook MC, Krouse RS. A meta-analysis of randomized trials: immediate stent placement vs. surgical bypass in the palliative management of malignant biliary obstruction. J Pain Symptom Manage 2014;47(2):307–14.
Zhang C, Yang Y, Wu P, Ma Y, Zhang H, Lin M, et al. [Prevention and treatment of complications for full-covered self-expanding removable metal stents in malignant obstructive jaundice]. Zhonghua Yi Xue Za Zhi 2015;95(6):416–9.
Stark A, Hines OJ. Endoscopic and operative palliation strategies for pancreatic ductal adenocarcinoma. Semin Oncol 2015;42(1):163–76.
Maire F, Sauvanet A. Palliation of biliary and duodenal obstruction in patients with unresectable pancreatic cancer: endoscopy or surgery? J Visc Surg 2013;150(Suppl 3):27–31.
Wehrmann T, Riphaus A, Frenz MB, Martchenko K, Stergiou N. Endoscopic pancreatic duct stenting for relief of pancreatic cancer pain. Eur J Gastroenterol Hepatol 2005;17(12):1395–400.
Räty S, Sand J, Piironen A, Nordback I. Complications of palliative hepaticojejunostomy and gastrojejunostomy in unresectable periampullary cancer: patient- and disease-related risk factors. Hepatogastroenterology 2006;53(67):133–7.
Gurusamy KS, Kumar S, Davidson BR. Prophylactic gastrojejunostomy for unresectable periampullary carcinoma. Cochrane Database Syst Rev 2013;2:CD008533.
Andtbacka RH, Evans DB, Pisters PW. Surgical and endoscopic palliation for pancreatic cancer. Minerva Chir 2004;59(2):123–36.
Grönroos JM, Gullichsen R, Laine S, Salminen P. Endoscopic palliation of malignant obstructive jaundice in extremely elderly patients: plastic stent is enough. Minim Invasive Ther Allied Technol 2010;19(2):122–4.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.