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Patients with pancreatic cancer often present with advanced disease; so, curative surgical resection is possible in a small
number of patients. Palliation in these patients focuses particularly on relief of biliary obstruction. Palliative treatment
modalities include both surgical and nonsurgical approaches. Biliary obstruction is initially treated with endoscopic biliary
stenting, plastic or metallic stents. Both of these provide similar initial relief of biliary obstruction; however, plastic
stents have a greater risk of occlusion and should be used in patients with short survival duration. Metallic stents
have a greater initial cost, but provide an overall costsaving in patients with expected survival more than 6 months.
There is no evidence of benefit from routine stenting of jaundiced patients before resection. Surgical palliation for biliary
obstruction should be primarily considered in patients who fail endoscopic or percutaneous biliary decompression or
who develop gastroduodenal obstruction, It is also indicated for patients with good performance status and expected survival
of over 6 months. Surgical decompression of biliary tree should be made with a choledochojejunostomy whenever
feasible, associated to a gastroduodenal bypass.
