Palliative Surgical Treatment for Patients with Advanced Periampullary Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Tao , TANG Lijun , TIAN Fuzhou , XIANG Ke , SHI Li , CUI Jianfeng.

PLA Center of General Surgery, General Hospital of Chengdu Command, Chengdu 610083, Sichuan Province, China;

Corresponding author：

Keywords：

Periampullary carcinoma; Palliative surgical treatment

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ObjectiveTo assess the value of palliative surgical treatment for patients with advanced periampullary carcinoma. MethodsThe clinical data of 292 cases of unresectably advanced periampullary carcinoma who had undergone palliative surgical treatment between June 1998 and June 2008 were analyzed retrospectively. Results
The mortality and incidence of complications after operation were 0.7% (2/292) and 24.0% (70/292), respectively. The average survival time was 10.3 months (range 4－29 months). Total bilirubin decreased to normal in 243 cases (83.2%) and decreased by 50% in 39 cases (13.4%) after operation. The totally effective rate was 96.6% (282/292). ConclusionsPalliative surgical treatment is a safe method for the patients with unresectably advanced periampullary carcinoma. Hepaticojejunostomy combined with gastrojejunostomy is recommended for these patients.

Citation： CHEN Tao,TANG Lijun,TIAN Fuzhou,XIANG Ke,SHI Li,CUI Jianfeng.. Palliative Surgical Treatment for Patients with Advanced Periampullary Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(4): 423-425. doi: Copy

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2.	Katsinelos P, Paikos D, Kountouras J, et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and costeffectiveness [J]. Surg Endosc, 2006, 20(10): 15871593.
3.	龚彪. 经内镜胆道金属支架引流术治疗恶性胆道梗阻的价值-附786例报告 [J]. 中国消化内镜, 2007, 1(1): 2022.
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6.	范震, 张啸, 张筱凤, 等. ERCP放置胆管内支架姑息治疗难以切除的恶性胆管梗阻 [J]. 现代消化及介入治疗, 2007, 12(1): 13.
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8.	Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction [J]. Gastrointest Endosc, 2005, 61(4): 528533.
9.	Lee CK, Barrios B, Bjarnason H. Biliary tree malignancies: the University of Minnesota experience [J]. J Surg Oncol, 1997, 65(4): 298305.
10.	Lesurtel M, Dehni N, Tiret E, et al. Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal [J]. J Gastrointest Surg, 2006, 10(2): 286291.
11.	Singh S, Sachdev AK, Chaudhary A, et al. Palliative surgical bypass for unresectable periampullary carcinoma [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(3): 308312.
12.	Kuhlmann KF, van Poll D, de Castro SM, et al. Initial and longterm outcome after palliative surgical drainage of 269 patients with malignant biliary obstruction [J]. Eur J Surg Oncol, 2007, 33(6): 757762.
13.	夏焱, 朱玉华, 张彪. 经内镜放置自膨式不带膜金属支架治疗胆管中下段恶性狭窄的疗效观察 [J]. 中国普外基础与临床杂志, 2004, 11(2): 151153.
14.	李海洋, 孙诚谊, 潘耀振, 等. 不同途径胆道支架置入治疗恶性梗阻性黄疸42例回顾分析 [J]. 中国普外基础与临床杂志, 2009, 16(4): 300303.
15.	Kim HO, Hwang SI, Kim H, et al. Quality of survival in patients treated for malignant biliary obstruction caused by unresectable pancreatic head cancer: surgical versus nonsurgical palliation [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(6): 643648.
16.	Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial [J]. Ann Surg, 1999, 230(3): 322328.
17.	Shyr YM, Su CH, Wu CE, et al. Prospective study of gastric outlet obstruction in unrestable periampillary adenocarcinoma [J]. World J Surg, 2000, 24(1): 6065.
18.	Liu YB, Huang L, Xian ZY, et al. Surgical treatment of patients with intermediateterminal pancreatic cancer [J]. World J Gastroenteral, 2006, 12(5): 765767.
19.	Van Heek NT, De Castro SM, van Eijck CH, et al. The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life [J]. Ann Surg, 2003, 238(6): 894905.
20.	付金强, 雷正明. 预防性胃肠转流在晚期壶腹周围癌外科治疗中的价值 [J]. 中华普通外科学文献(电子版), 2007, 1(2): 6774.

1. Watanapa P, Williamson RC. Surgical palliation for pancreatic cancer: developments during the past two decades [J]. Br J Surg, 1992, 79(1): 820.
2. Katsinelos P, Paikos D, Kountouras J, et al. Tannenbaum and metal stents in the palliative treatment of malignant distal bile duct obstruction: a comparative study of patency and costeffectiveness [J]. Surg Endosc, 2006, 20(10): 15871593.
3. 龚彪. 经内镜胆道金属支架引流术治疗恶性胆道梗阻的价值-附786例报告 [J]. 中国消化内镜, 2007, 1(1): 2022.
4. 勾承月, 秦鸣放, 王庆, 等. 胆道支架介入治疗恶性胆道梗阻136例临床分析 [J]. 中国微创外科杂志, 2010, 10(5): 412414.
5. 辛波, 张林波, 姜喜远, 等. 恶性梗阻性黄疸介入治疗与手术引流比较 [J]. 中国普外基础与临床杂志, 2010, 17(3): 233236.
6. 范震, 张啸, 张筱凤, 等. ERCP放置胆管内支架姑息治疗难以切除的恶性胆管梗阻 [J]. 现代消化及介入治疗, 2007, 12(1): 13.
7. Dahlstrand U, Sandblom G, Eriksson LG, et al. Primary patency of percutaneously inserted selfexpanding metallic stents in patients with malignant biliary obstruction [J]. HPB (Oxford), 2009, 11(4): 358363.
8. Kahaleh M, Tokar J, Conaway MR, et al. Efficacy and complications of covered Wallstents in malignant distal biliary obstruction [J]. Gastrointest Endosc, 2005, 61(4): 528533.
9. Lee CK, Barrios B, Bjarnason H. Biliary tree malignancies: the University of Minnesota experience [J]. J Surg Oncol, 1997, 65(4): 298305.
10. Lesurtel M, Dehni N, Tiret E, et al. Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal [J]. J Gastrointest Surg, 2006, 10(2): 286291.
11. Singh S, Sachdev AK, Chaudhary A, et al. Palliative surgical bypass for unresectable periampullary carcinoma [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(3): 308312.
12. Kuhlmann KF, van Poll D, de Castro SM, et al. Initial and longterm outcome after palliative surgical drainage of 269 patients with malignant biliary obstruction [J]. Eur J Surg Oncol, 2007, 33(6): 757762.
13. 夏焱, 朱玉华, 张彪. 经内镜放置自膨式不带膜金属支架治疗胆管中下段恶性狭窄的疗效观察 [J]. 中国普外基础与临床杂志, 2004, 11(2): 151153.
14. 李海洋, 孙诚谊, 潘耀振, 等. 不同途径胆道支架置入治疗恶性梗阻性黄疸42例回顾分析 [J]. 中国普外基础与临床杂志, 2009, 16(4): 300303.
15. Kim HO, Hwang SI, Kim H, et al. Quality of survival in patients treated for malignant biliary obstruction caused by unresectable pancreatic head cancer: surgical versus nonsurgical palliation [J]. Hepatobiliary Pancreat Dis Int, 2008, 7(6): 643648.
16. Lillemoe KD, Cameron JL, Hardacre JM, et al. Is prophylactic gastrojejunostomy indicated for unresectable periampullary cancer? A prospective randomized trial [J]. Ann Surg, 1999, 230(3): 322328.
17. Shyr YM, Su CH, Wu CE, et al. Prospective study of gastric outlet obstruction in unrestable periampillary adenocarcinoma [J]. World J Surg, 2000, 24(1): 6065.
18. Liu YB, Huang L, Xian ZY, et al. Surgical treatment of patients with intermediateterminal pancreatic cancer [J]. World J Gastroenteral, 2006, 12(5): 765767.
19. Van Heek NT, De Castro SM, van Eijck CH, et al. The need for a prophylactic gastrojejunostomy for unresectable periampullary cancer: a prospective randomized multicenter trial with special focus on assessment of quality of life [J]. Ann Surg, 2003, 238(6): 894905.
20. 付金强, 雷正明. 预防性胃肠转流在晚期壶腹周围癌外科治疗中的价值 [J]. 中华普通外科学文献(电子版), 2007, 1(2): 6774.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Palliative Surgical Treatment for Patients with Advanced Periampullary Carcinoma

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