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Table of Contents
Vol. 5, No. 4-5, 2005
Issue release date: 2005
Section title: Review
Pancreatology 2005;5:325–329
(DOI:10.1159/000086533)

Current Status of Laparoscopic Biliary Bypass in the Management of Non-Resectable Peri-Ampullary Cancer

Date R.S. · Siriwardena A.K.
Hepatobiliary Unit, Department of Surgery, Manchester Royal Infirmary, Manchester, UK
email Corresponding Author

Abstract

Background: In patients with non-resectable peri-ampullary cancer, optimization of quality of life is an important goal. Although endoscopic palliation is widely used, the proponents of laparoscopic biliary bypass claim that this procedure alters management towards surgery. However, the evidence base for selection of laparoscopic bypass is limited and the aim of this report is to scrutinize the available evidence in order to assess the current role of this procedure. Methods: A computerised literature search was made of the Medline database for the period from January 1966 to December 2004. Searches identified 12 reports of laparoscopic palliation for peri-ampullary cancer. These reports were retrieved and data analysed in the following categories: type of bypass; combination with other procedures; complication and outcome. Results: Laparoscopic cholecystoenterostomy is the commonest form of laparoscopic biliary bypass practiced. Of the 52 reported cases undergoing laparoscopic biliary bypass, 40 underwent laparoscopic cholecystojejunostomy, 6 laparoscopic choledochoduodenostomy and 6 underwent laparoscopic hepaticoje- junostomy. Conclusion: Current evidence does not justify the incorporation of laparoscopic biliary bypass techniques into contemporary evidence-based management algorithms for patients with non-resectable periampullary cancer.

© 2005 S. Karger AG, Basel and IAP


  

Key Words

  • Laparoscopy
  • Biliary bypass
  • Peri-ampullary cancer

References

  1. Wagner M, Redaelli C, Lietz M, Seiler A, Friess H, Buchler W: Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586–594.
  2. John TG, Aseervatham LR: Investigation of hepatobiliary and pancreatic malignancy; in Garden OJ (ed): Hepatobiliary and Pancreatic Surgery, ed 2. Harcourt Publishers Ltd., 2001, pp 1–75.
  3. Maosheng D, Ohtsuka T, Ohuchida J, Inoue K, Yokohata K, Yamaguchi K, Chijiiwa K, Tanaka M: Surgical bypass versus metallic stent for unresectable pancreatic cancer. J Hepatobiliary Pancreat Surg 2001;8:367–373.
  4. Ammori BJ: Pancreatic surgery in the laparoscopic era. JOP 2003;4:187–192.

    External Resources

  5. Shimi S, Banting S, Cuschieri A: Laparoscopy in the management of pancreatic cancer: Endoscopic cholecystojejunostomy for advanced disease. Br J Surg 1992;79:317–319.
  6. Fletcher DR, Jones RM: Laparoscopic cholecystojejunostomy as palliation for obstructive jaundice in inoperable carcinoma of pancreas. Surg Endosc 1992;6:147–149.
  7. Hawasli A: Laparoscopic cholecystojejunostomy for obstructing pancreatic cancer: Technique and report of two cases. J Laparoendosc Surg 1992;6:351–355.

    External Resources

  8. Tarnasky PR, England RE, Lail LM, Pappas TN, Cotton PB: Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy. Ann Surg 1995;221:265–271.
  9. Raj PK, Mahoney P. Linderman C: Laparoscopic cholecystojejunostomy: A technical application in unresectable biliary obstruction. J Laparoendosc Adv Surg Tech A 1997;7:47–52.
  10. Rhodes M, Nathanson L, Fielding G: Laparoscopic biliary and gastric bypass: A useful adjunct in the treatment of carcinoma of the pancreas. Gut 1995;36:778–780.
  11. Chekan EG, Clark L, Wu J, Pappas TN, Eubanks S: Laparoscopic biliary and enteric bypass. Semin Surg Oncol 1999;16:313–320.
  12. Casaccia M, Diviacco P, Molinello P, Danovaro L, Casaccia M: Laparoscopic palliation of unresectable pancreatic cancers: Preliminary results. Euro J Surg 1999;165:556–559.
  13. Charukhchyan SA, Lucas GW: Lesser sac endoscopy and laparoscopy in pancreatic carcinoma definitive diagnosis, staging and palliation. Am Surg 1998;64:809–814.
  14. Kuriansky J, Saenz A, Astudillo E, Cardona V, Fernandez-Cruz L: Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas. Surg Endosc 2000;14:179–181.
  15. Rothlin M, Schob O, Weber M: Laparoscopic gastro- and hepaticojejunostomy for palliation of pancreatic cancer: A case controlled study. Surg Endosc 1999;13:1065–1069.
  16. Machado MA, Rocha JR, Herman P, Montagnini AL, Machado MC: Alternative technique of laparoscopic hepaticojejunostomy for advanced pancreatic head cancer. Surg Laparosc Endosc Percutan Tech 2000;10:174–177.
  17. Gentileschi P, Kini S, Gagner M: Palliative laparoscopic hepatico- and gastrojejunostomy for advanced pancreatic cancer. JSLS 2002;6:331–338.

    External Resources

  18. Di Fronzo LA, Egrari S, O’Connell T: Choledochoduodenostomy for palliation in unresectable pancreatic cancer. Arch Surg 1998;133:820–825.
  19. Tinoco R, El-Kadre L, Tinoco A: Laparoscopic choledochoduodenostomy. J Laparoendosc Adv Surg Tech 1999;9:123–126.
  20. Ali AS, Ammori BJ: Concomitant laparoscopic gastric and biliary bypass and bilateral thoracoscopic splanchnotomy: The full package of minimally invasive palliation for pancreatic cancer. Surg Endosc 2003;17:2028–2031.
  21. Urbach DR, Bell CM, Swanstrom LL, Hansen PD: Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer. Ann Surg 2003;237:86–93.
  22. Luque-de LeSn E, Tsiotos GG, Balsiger B, Barnwell J, Burgart LJ, Sarr MG: Staging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate. J Gastrointest Surg 1999;3:111–118.

  

Author Contacts

A.K. Siriwardena, MD, FRCS
HPB Unit, Department of Surgery
Manchester Royal Infirmary, Oxford Road
Manchester M13 9WL (UK)
Tel. +44 161 276 4250, Fax +44 161 276 4530, E-Mail ajith.siriwardena@cmmc.nhs.uk

  

Article Information

Conflicts of interest: None known.

Published online: June 23, 2005
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 3, Number of References : 22

  

Publication Details

Pancreatology

Vol. 5, No. 4-5, Year 2005 (Cover Date: 2005)

Journal Editor: Urrutia, R. (Rochester, Minn.)
ISSN: 1424–3903 (print), 1424–3911 (Online)

For additional information: http://www.karger.com/pan


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

Background: In patients with non-resectable peri-ampullary cancer, optimization of quality of life is an important goal. Although endoscopic palliation is widely used, the proponents of laparoscopic biliary bypass claim that this procedure alters management towards surgery. However, the evidence base for selection of laparoscopic bypass is limited and the aim of this report is to scrutinize the available evidence in order to assess the current role of this procedure. Methods: A computerised literature search was made of the Medline database for the period from January 1966 to December 2004. Searches identified 12 reports of laparoscopic palliation for peri-ampullary cancer. These reports were retrieved and data analysed in the following categories: type of bypass; combination with other procedures; complication and outcome. Results: Laparoscopic cholecystoenterostomy is the commonest form of laparoscopic biliary bypass practiced. Of the 52 reported cases undergoing laparoscopic biliary bypass, 40 underwent laparoscopic cholecystojejunostomy, 6 laparoscopic choledochoduodenostomy and 6 underwent laparoscopic hepaticoje- junostomy. Conclusion: Current evidence does not justify the incorporation of laparoscopic biliary bypass techniques into contemporary evidence-based management algorithms for patients with non-resectable periampullary cancer.

© 2005 S. Karger AG, Basel and IAP


  

Author Contacts

A.K. Siriwardena, MD, FRCS
HPB Unit, Department of Surgery
Manchester Royal Infirmary, Oxford Road
Manchester M13 9WL (UK)
Tel. +44 161 276 4250, Fax +44 161 276 4530, E-Mail ajith.siriwardena@cmmc.nhs.uk

  

Article Information

Conflicts of interest: None known.

Published online: June 23, 2005
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 3, Number of References : 22

  

Publication Details

Pancreatology

Vol. 5, No. 4-5, Year 2005 (Cover Date: 2005)

Journal Editor: Urrutia, R. (Rochester, Minn.)
ISSN: 1424–3903 (print), 1424–3911 (Online)

For additional information: http://www.karger.com/pan


Article / Publication Details

First-Page Preview
Abstract of Review

Published online: 6/23/2005
Issue release date: 2005

Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 3

ISSN: 1424-3903 (Print)
eISSN: 1424-3911 (Online)

For additional information: http://www.karger.com/PAN


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Wagner M, Redaelli C, Lietz M, Seiler A, Friess H, Buchler W: Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586–594.
  2. John TG, Aseervatham LR: Investigation of hepatobiliary and pancreatic malignancy; in Garden OJ (ed): Hepatobiliary and Pancreatic Surgery, ed 2. Harcourt Publishers Ltd., 2001, pp 1–75.
  3. Maosheng D, Ohtsuka T, Ohuchida J, Inoue K, Yokohata K, Yamaguchi K, Chijiiwa K, Tanaka M: Surgical bypass versus metallic stent for unresectable pancreatic cancer. J Hepatobiliary Pancreat Surg 2001;8:367–373.
  4. Ammori BJ: Pancreatic surgery in the laparoscopic era. JOP 2003;4:187–192.

    External Resources

  5. Shimi S, Banting S, Cuschieri A: Laparoscopy in the management of pancreatic cancer: Endoscopic cholecystojejunostomy for advanced disease. Br J Surg 1992;79:317–319.
  6. Fletcher DR, Jones RM: Laparoscopic cholecystojejunostomy as palliation for obstructive jaundice in inoperable carcinoma of pancreas. Surg Endosc 1992;6:147–149.
  7. Hawasli A: Laparoscopic cholecystojejunostomy for obstructing pancreatic cancer: Technique and report of two cases. J Laparoendosc Surg 1992;6:351–355.

    External Resources

  8. Tarnasky PR, England RE, Lail LM, Pappas TN, Cotton PB: Cystic duct patency in malignant obstructive jaundice. An ERCP-based study relevant to the role of laparoscopic cholecystojejunostomy. Ann Surg 1995;221:265–271.
  9. Raj PK, Mahoney P. Linderman C: Laparoscopic cholecystojejunostomy: A technical application in unresectable biliary obstruction. J Laparoendosc Adv Surg Tech A 1997;7:47–52.
  10. Rhodes M, Nathanson L, Fielding G: Laparoscopic biliary and gastric bypass: A useful adjunct in the treatment of carcinoma of the pancreas. Gut 1995;36:778–780.
  11. Chekan EG, Clark L, Wu J, Pappas TN, Eubanks S: Laparoscopic biliary and enteric bypass. Semin Surg Oncol 1999;16:313–320.
  12. Casaccia M, Diviacco P, Molinello P, Danovaro L, Casaccia M: Laparoscopic palliation of unresectable pancreatic cancers: Preliminary results. Euro J Surg 1999;165:556–559.
  13. Charukhchyan SA, Lucas GW: Lesser sac endoscopy and laparoscopy in pancreatic carcinoma definitive diagnosis, staging and palliation. Am Surg 1998;64:809–814.
  14. Kuriansky J, Saenz A, Astudillo E, Cardona V, Fernandez-Cruz L: Simultaneous laparoscopic biliary and retrocolic gastric bypass in patients with unresectable carcinoma of the pancreas. Surg Endosc 2000;14:179–181.
  15. Rothlin M, Schob O, Weber M: Laparoscopic gastro- and hepaticojejunostomy for palliation of pancreatic cancer: A case controlled study. Surg Endosc 1999;13:1065–1069.
  16. Machado MA, Rocha JR, Herman P, Montagnini AL, Machado MC: Alternative technique of laparoscopic hepaticojejunostomy for advanced pancreatic head cancer. Surg Laparosc Endosc Percutan Tech 2000;10:174–177.
  17. Gentileschi P, Kini S, Gagner M: Palliative laparoscopic hepatico- and gastrojejunostomy for advanced pancreatic cancer. JSLS 2002;6:331–338.

    External Resources

  18. Di Fronzo LA, Egrari S, O’Connell T: Choledochoduodenostomy for palliation in unresectable pancreatic cancer. Arch Surg 1998;133:820–825.
  19. Tinoco R, El-Kadre L, Tinoco A: Laparoscopic choledochoduodenostomy. J Laparoendosc Adv Surg Tech 1999;9:123–126.
  20. Ali AS, Ammori BJ: Concomitant laparoscopic gastric and biliary bypass and bilateral thoracoscopic splanchnotomy: The full package of minimally invasive palliation for pancreatic cancer. Surg Endosc 2003;17:2028–2031.
  21. Urbach DR, Bell CM, Swanstrom LL, Hansen PD: Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer. Ann Surg 2003;237:86–93.
  22. Luque-de LeSn E, Tsiotos GG, Balsiger B, Barnwell J, Burgart LJ, Sarr MG: Staging laparoscopy for pancreatic cancer should be used to select the best means of palliation and not only to maximize the resectability rate. J Gastrointest Surg 1999;3:111–118.