Quality of survival in patients treated for malignant biliary obstruction caused by unresectable pancreatic head cancer: Surgical versus non-surgical palliation

Background: Appropriate palliation for unresectable pancreatic head cancer is most important. This study was undertaken to compare the survival of patients with biliary obstruction caused by unresectable pancreatic head cancer after surgical and non-surgical palliation. Methods: We retrospectively reviewed 69 patients who underwent palliative treatment for unresectable pancreatic head cancer. Fifty-two patients with locally advanced disease (local vascular invasion) and 17 with distant metastatic disease were included. The patients were divided into two groups, surgical and non-surgical palliation. Results: Thirty-eight patients underwent biliary bypass surgery and 31 had percutaneous transhepatic biliary drainage (PTBD). There was no significant difference in the early complications, successful biliary drainage, recurrent jaundice, and 30-day mortality between surgical palliation and PTBD. However, in 52 patients whose tumor was unresectable secondary to local vascular invasion, the rate of recurrent jaundice after successful surgical biliary palliation was lower than that in patients who had nonsurgical palliation (P<0.05). The patients who underwent surgical palliation had a longer hospital-free survival rate (P<0.001), although they had a longer postoperative hospital stay (P=0.004) during the first admission period. Conclusions: In patients with preoperative evaluations showing potentially resectable tumors and/or no metastatic lesions, surgical exploration should be performed. Thus, in patients who have unresectable cancer or limited metastatic disease on exploration, surgical palliation should be performed for longer survival and better quality of survival.