Faculty Bibliography

The previously unaddressed impact of radiotherapy and vagotomy on palliative gastroenterostomy (GE) in patients with unresectable pancreatic cancer was studied. Sixty-eight patients were retrospectively evaluated. A higher overall incidence of complications was found in the group (N = 44) undergoing irradiation as well as gastroenterostomy compared to a group undergoing gastroenterostomy alone. The increased complications were due to 16 episodes of bleeding among the irradiated patients. Rates of obstructive complications were similar for both groups (20%). Rates of bleeding were highest among patients undergoing prophylactic GE and irradiation compared to those receiving GE alone. Vagotomy in 12 patients who were irradiated did not appear to protect against bleeding. We found the irradiated prophylactic GE to provide poor palliation in patients with unresectable pancreatic cancer and recommend it not be performed if radiotherapy is to be used for attempt in local control of unresectable pancreatic cancer.

Intra-abdominal spread of tumor is a common cause of treatment failure in patients with pancreatic cancer. We have reviewed 62 patients with pancreatic cancer undergoing repeat laparotomy in order to learn what factors are associated with the high risk of intra-abdominal metastases. Patients who underwent two or more operative biopsy procedures were at a markedly increased risk of developing intra-abdominal tumor seeding. These metastases were not detectable by preoperative computed tomography scan or ultrasound. This information affirms that multiple biopsies of pancreatic tumors increase the risk of local disease failure, and regimens based on nonoperative staging are likely to incorrectly minimize the extent of tumor involvement.

Ninety-five patients with known cancer who developed bowel obstruction were reviewed in an effort to evaluate the reliability of preadmission performance status as a predictor of outcome of therapy. Based on the review, a number of conclusions can be reached. Performance status, which is more easily measured than stage of disease at admission, is correlated with successful resolution of obstruction and survival. Many patients with known cancer who develop bowel obstruction have a nonmalignant cause of obstruction. Prolonged nonoperative treatment of cancer patients with bowel obstruction is unlikely to be successful and is fraught with complications.