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dc.contributor.authorNikfarjam, Mehrdaden
dc.contributor.authorHadj, Andrew Ken
dc.contributor.authorMuralidharan, Vijayaragavanen
dc.contributor.authorTebbutt, Niall Cen
dc.contributor.authorFink, Michael Aen
dc.contributor.authorJones, Robert Men
dc.contributor.authorStarkey, Grahamen
dc.contributor.authorVaughan, Rhys Ben
dc.contributor.authorMarshall, Alexander Wen
dc.contributor.authorChristophi, Christopheren
dc.identifier.citationIndian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology 2012; 32(2): 82-9en
dc.description.abstractPatients with periampullary cancers may not be suitable for curative resection due to locally advanced disease, metastases, or poor health. Biliary stenting and surgical bypass are utilized for symptom control, but the true benefit of one technique over the other is not clear.A retrospective analysis of case records was undertaken of patients with periampullary (pancreatic head/uncinate process, distal bile duct, and ampulla of Vater and surrounding duodenum) malignancy treated between June 2004 and June 2010 in a tertiary center by palliative biliary stenting or palliative surgical bypass.Of the 69 patients included in the analysis, combined biliary and gastric bypass was performed on 28, while 41 underwent biliary stent (metallic, n = 39) insertion. Patients undergoing stenting were significantly older and less likely to be offered chemotherapy than those from the surgical bypass group. Overall, there were significantly more complications in the stent insertion group (85 %) than the surgical bypass group (36 %) (p = 0.003). The stent group required significantly more subsequent procedures than the surgical bypass group. Metal stent obstruction occurred in 16 of 39 (41 %) patients, with a median stent patency of 224 days. The overall median survival of patients in this study was 7 months with no significant difference between the groups (p = 0.992). The presence of metastases at presentation was the only independent factor associated with decreased survival.There was no survival difference between stenting vs. surgical bypass for palliation of periampullary cancer. There was, however, a high rate of stent occlusion and need for repeat procedures in patients treated by metal stenting, suggesting that stenting may be best suited to patients predicted as having the shortest survival.en
dc.subject.otherAged, 80 and overen
dc.subject.otherAmpulla of Vateren
dc.subject.otherAnastomosis, Roux-en-Y.adverse effectsen
dc.subject.otherCommon Bile Duct Neoplasms.pathology.surgeryen
dc.subject.otherKaplan-Meier Estimateen
dc.subject.otherMiddle Ageden
dc.subject.otherNeoplasm Metastasisen
dc.subject.otherPalliative Care.methodsen
dc.subject.otherPancreatic Neoplasms.pathology.surgeryen
dc.subject.otherProsthesis Failure.adverse effectsen
dc.subject.otherRetrospective Studiesen
dc.subject.otherStents.adverse effectsen
dc.titleBiliary stenting versus surgical bypass for palliation of periampullary malignancy.en
dc.typeJournal Articleen
dc.identifier.journaltitleIndian journal of gastroenterology : official journal of the Indian Society of Gastroenterologyen
dc.identifier.affiliationUniversity of Melbourne, Department of Surgery, Austin Health, LTB 8, Studley Road, Heidelberg, Melbourne, Victoria 3084, Australiaen
dc.type.austinJournal Articleen
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