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Title: Biliary stenting versus surgical bypass for palliation of periampullary malignancy.
Austin Authors: Nikfarjam, Mehrdad ;Hadj, Andrew K;Muralidharan, Vijayaragavan ;Tebbutt, Niall C ;Fink, Michael A ;Jones, Robert M ;Starkey, Graham;Vaughan, Rhys B ;Marshall, Alexander W;Christophi, Christopher 
Affiliation: Surgery (University of Melbourne)
Issue Date: 16-Nov-2012
Publication information: Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology 2012; 32(2): 82-9
Abstract: Patients 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.
DOI: 10.1007/s12664-012-0274-1
Journal: Indian Journal of Gastroenterology : Official Journal of the Indian Society of Gastroenterology
Type: Journal Article
Subjects: Aged
Aged, 80 and over
Ampulla of Vater
Anastomosis, Roux-en-Y.adverse effects
Common Bile Duct
Kaplan-Meier Estimate
Middle Aged
Neoplasm Metastasis
Palliative Care.methods
Prosthesis Failure.adverse effects
Retrospective Studies
Stents.adverse effects
Appears in Collections:Journal articles

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