PALLIATION IN PANCREAS CANCERS

Abstract

To evaluate and compare operative and non-operative treatment modalities in the palliative care of pancreas carcinoma with local invasion and/or hepatic metastasis defined by pre-operative evaluation.

Palliative treatment modalities for pancreas carcinoma with early local invasion and/or hepatic metastases can be operative or non-operative. Especially, the contribution of the chosen method of treatment to survival, cost, mortality and morbidity rates has suggested different results.

The data of 72 patients with pancreas carsinoma (55 males, 19 females; aged 38-82 years, mean 52±3.14) treated between 1993 and 2001 were evaluated retrospectively. The surgical and non-surgical palliative methods were compared for cost-effeciency, mortality and morbidity rates and survival. Kaplan-Meier and Mann-Whitney U tests were used for the relevant comparisons.

27 patients (37.5%) underwent curative surgery, 16 (22.2%) palliative surgery and 29 (40.3%) non-surgical palliative methods. Considering patients who were treated palliatively, it was noted that percutaneous biliary stents were placed in 25 patients (55.5%), surgical palliation was accomplished in 16 (35.5%) and non-surgical pain palliation in 4 (9%). While patients with biliary stents experienced no early complications, the complication rate was 37.5% in the surgical palliation group. Late-term complication rate was 24% in the stent group and 25% in the surgical palliation group. The survival rates of the two groups were comparable. Because of the high complication rate and long hospitalization period, the cost of surgical palliation reached to that of stent placement.

The results, suggest that it is better to plan the method of palliation to the pancreas carcinoma patients with late local invasion and/or hepatic metastases on the basis of operation risk and life expectancy factors.