A wait-and-see strategy with subsequent self-expanding metal stent on demand is superior to prophylactic bypass surgery for unresectable periampullary cancer

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
Caroline WilliamssonClaes Jönsson

Abstract

A patient with unresectable periampullary malignancy found at laparotomy has traditionally received a prophylactic double bypass (biliary and duodenal), associated with considerable morbidity. With modern endoscopic treatments, surgical bypass has become questionable. This study aims to compare the two strategies. Sahlgrenska University Hospital (SU) performs a double bypass (DoB) routinely, and Skåne University Hospital Lund (SUL) secures biliary drainage endoscopically and treats only symptomatic duodenal obstruction (Wait and See, WaS). Between 2004 and 2013, 73 patients from SU and 70 from SUL were retrospectively identified. Demographics, tumour-related factors and postoperative outcomes during the remaining lifetime were noted. The DoB group had significantly more complications (67% vs. 31%, p = 0.00002) and longer hospital stay (14 vs. 8 days, p = 0.001) than the WaS-group. The two groups had similar proportion of patients in need of readmission. The DoB patients and the WaS patients with metallic biliary stents were comparable regarding their need of re-interventions and hospitalisation due to biliary obstruction. Surgical duodenal bypass did not prevent future duodenal obstructions. Patients with unresectable periampul...Continue Reading

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Citations

Apr 18, 2020·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·Emil SahlströmBodil Andersson
Nov 7, 2016·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·M Schrempf, M Anthuber
May 1, 2020·Clinical and Translational Gastroenterology·Anna FábiánZoltán Szepes
Sep 21, 2019·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Kathryn A StackhouseA James Moser

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