Palliative options in the treatment of pancreatic adenocarcinoma

Abstract

INTRODUCTION/BACKGROUND: The pancreatic adenocarcinoma (PA) is one of the most lethal malignancies being the fourth leading cause of cancer deaths worldwide. Despite the significant progress in diagnostic modalities the PA is still diagnosed at late stages when curative treatment is no longer possible. This unfavorable situation directs the clinician`s attention towards palliation and quality of life improvement.

MATERIALS AND METHODS: We performed a literature review of the recent developments in the area of palliative care for pancreatic cancer patients regarding the management of obstructive jaundice, pain and intestinal obstruction. The experience of our clinic with conventional surgery and nonsurgical methods is analyzed and presented.

OUR RESULTS: We report our experience with group of 45 patients, one part of them received conventional surgical treatment, and the other one underwent endoscopic treatment. Both endoscopic stent insertion and surgical bypass appear to be effective treatments, but nonoperative palliation seems to be associated with lower complication rates, lower procedure-related mortality rates, and shorter initial periods of hospitalization compared with surgical palliation. In one patient we performed recanalization of a self-expandable metalic stent by inserting a plastic stent into it. The jaundice was relieved successfully.

CONCLUSION: The management of PA patient remains a challenge in spite of the clear progress made in diagnostic studies, surgical and palliation treatments. Multidisciplinary approach is necessary to optimize the overall care. Considering the late diagnosis of the majority of PA patients, palliative techniques should not be neglected, but well mastered.