[Palliative treatment of pancreatic carcinoma. Comparison between 2 successive observation periods]. / Il trattamento palliativo del carcinoma pancreatico. Confronto fra due successivi periodi di osservazione.

ABSTRACT

Explorative laparotomies and palliative surgery for pancreatic carcinoma have been reduced due to improved diagnostic tools, the spread of laparoscopic techniques and the growing use of external biliary drainage and endoprostheses. By comparing two successive observation periods the authors point out that, owing to the good results obtained, mini-invasive surgery is more frequently used in the management of obstructive jaundice than biliodigestive surgical derivations. Of these, hepatico-jejunostomy is preferable to duodenal anastomosis due to the latter's frequent involvement by the primary tumour. The authors also consider it inappropriate to increase operative morbidity through the systematic association of gastroenteric with biliodigestive derivation, except in cases of symptomatic or radiologically or endoscopically ascertained duodenal stenosis and when the objective finding of visceral involvement leads to the supposition of its imminent obliteration. The indications for surgical splannicectomy have also been reduced with the spread of percutaneous alcoholization of the celiac plexy in cases which resist analgesic treatment using a parenteral route.