Treatment of Pancreatic Cancer: Minimally Invasive Laparoscopy May Be Used to Alleviate Stomach and Bile Duct Obstruction
The use of a procedure called a laparoscopy may allow treatment of the blockage of the bile ducts and stomach (at the small intestine) that often occurs in persons with pancreatic cancer, according to a new report by Spanish researchers. The laparoscopy appears to achieve the same results as the more commonly performed surgical procedure, but is much less invasive.
The pancreas is an organ that is surrounded by the stomach, small intestine, bile ducts (tubes that connect the liver to the small intestine), gallbladder, liver, and spleen. The pancreas helps the body to break down food and produces hormones, such as insulin, to regulate the body’s storage and use of food. Depending on the stage of disease (extent of cancer at the time of diagnosis), pancreatic cancer may be treated with surgery, radiation therapy, chemotherapy, and/or biologic therapy to fight the cancer, relieve some of the symptoms of cancer, and/or prolong survival time.
Some persons who have pancreatic cancer undergo surgery to remove part or all of the pancreas and upper section of the small intestine, called the duodenum, to remove the cancer. However, for many persons, the cancer has spread and cannot be surgically removed. In these persons, other surgical procedures may be performed to relieve the symptoms and complications of the disease.
The pancreatic ducts, tubes that carry enzymes from the pancreas, and the bile ducts empty into the duodenum at approximately the same location. When cancer of the pancreas begins to grow in the area of the pancreatic and bile ducts, it can block these ducts and the stomach from emptying into the duodenum. For individuals with this type of cancer, a surgery called a gastrojejunostomy may be performed to connect the bile ducts and the stomach to the second section of the small intestine, the jejunum. This procedure allows the stomach and bile ducts to bypass the duodenum and empty directly into the jejunum, hopefully enabling persons with this disease to continue to eat and drink relatively normally. However, a gastrojejunostomy can be a complex procedure, and less invasive techniques are under study. Once such approach is the use of an endoscope, a flexible tube that can be inserted into the body through a small hole. Using the endoscope, a surgeon can see the area, collect samples, and perform various surgical techniques, without the invasiveness of an open surgery. When an endoscope is used in the abdominal area, it is called a laparoscope, the procedure a laparoscopy.
Researchers in Spain treated 12 persons who had inoperable pancreatic cancer that blocked the bile ducts and stomach from emptying into the duodenum. All were jaundiced. The researchers performed a laparoscopy, lasting an average of 1.5 hours, to connect the bile ducts and the stomach to the jejunum in all 12 patients. The average length of the hospital stay was 1 week. After the procedure, none of the patients had a return of the jaundice and all were able to continue eating and drinking relatively normally. The average survival time was 3 months. One patient died 2 days after the procedure, and 3 patients had complications: 2 acquired infections and 1 developed pneumonia.
These researchers concluded that a laparoscopy is a safe and effective procedure for relieving stomach and bile duct obstruction in persons with inoperable pancreatic cancer. Individuals who have this type of disease may wish to talk with their doctor about the risks and benefits of laparoscopy (versus other procedures) and of participating in a clinical trial in which promising new treatment approaches are being studied.
(Surgical Endoscopy, Vol 14, No 2, pp 179-181, 2000)