Brief Articles
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Feb 28, 2009; 15(8): 978-982
Published online Feb 28, 2009. doi: 10.3748/wjg.15.978
Surgical palliation of unresectable pancreatic head cancer in elderly patients
Sang Il Hwang, Hyung Ook Kim, Byung Ho Son, Chang Hak Yoo, Hungdai Kim, Jun Ho Shin
Sang Il Hwang, Hyung Ook Kim, Byung Ho Son, Chang Hak Yoo, Hungdai Kim, Jun Ho Shin, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 110-746, South Korea
Author contributions: Hwang SI analyzed and interpreted the data and wrote the draft manuscript; Kim HO and Son BH contributed substantially to the recruitment of patients, acquisition of data for the study, and preparation of the manuscript; Yoo CH and Kim H contributed to the design and set up of the study, also analyzed and interpreted the data; Shin JH contributed substantially to the conception administration support and overall supervision of the study, he critically revised the manuscript.
Correspondence to: Jun Ho Shin, MD, Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongno-Ku, Seoul 110-746, South Korea. junho0521.shin@samsung.com
Telephone: +82-2-20012138  
Fax: +82-2-20012131
Received: September 11, 2008
Revised: October 26, 2008
Accepted: November 2, 2008
Published online: February 28, 2009
Abstract

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer.

METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life.

RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively).

CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer.

Keywords: Adenocarcinoma; Elderly; Palliative surgery; Pancreas neoplasms