B47. Palliative surgery in pancreatic and periampullary tumors.

Page created on October 4, 2021. Last updated on October 6, 2021 at 12:28

Introduction

For introduction, etiology, and pathology, see the corresponding pathology 2 topic. For clinical features, diagnosis, and curative treatment, see topic B55.

Palliative surgery for pancreatic and periampullary tumours

Many cases of pancreatic and periampullary cancer are irresectable and therefore incurable. Palliative surgery is therefore common.

Palliative surgery may be indicated for jaundice or gastric outlet obstruction in people with irresectable pancreatic cancer. These are usually managed with the placement of stents into the obstructed biliary tree or obstructed duodenum with ERCP. In case stent placement is impossible or insufficient, a bypass operation may be necessary.

Palliative double bypass operation involves hepaticojejunostomy and gastrojejunostomy, i.e., diverting biliary flow to the jejunum rather than the duodenum, and diverting food passage to the jejunum as well.

Non-surgical palliative treatment

Pancreatic cancer pain usually requires opioid analgesics. Because the tumour may be close to the coeliac plexus, drugs effective against neuropathic pain may be used as adjuvants.

A permanent coeliac ganglion block (coeliac plexus neurolysis) can be used for pain management in case pharmacological therapy is insufficient. This involves radiographically guided puncture of the coeliac ganglion, followed by installation of ethanol, which destroys the nerve tissue permanently. Injection of a local anaesthetic instead produces temporary pain relief (and is mostly used for chronic pancreatitis, see topic B54).

Chemotherapy (with gemcitabine and erlotinib) may also be used for palliative therapy.


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B48. The notion and statement of brain death. Medico-legal prerequisites.

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Surgery – Traumatology

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