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Surgery for Malignant Jaundice

Surgery for Malignant Jaundice Abstract Relatively little attention has been given to factors affecting surgical morbidity and mortality in patients with obstructive jaundice due to malignancy. The indications for pancreaticoduodenectomy have received more attention; however, this procedure is possible in only 5% to 20% of cases.1-4 When only palliative procedures are possible the benefits of this surgery may be lost, owing to postoperative complications or death. These considerations have promoted a review of the clinical experiences with jaundice caused by malignancy. Hypotension leading to uremia has been found to be the most serious complication. Better preoperative preparation with blood volume replacement has been the only factor effective in decreasing the surgical mortality. Although the cure rate remains poor, the over-all survival has been improved through a lower operative mortality. The accuracy and dangers of biopsy, indications for gastroenterostomy at the time of surgery for inoperable lesions, and improvement in mortality rate will be discussed. References 1. Dennis, C., and Varco, R. L.: Survival for More Than Five Years After Pancreatoduodenectomy for Cancers of the Ampulla and Pancreatic Head , Surgery 39:92, 1957. 2. Cattell, R. B.; Warren, K. W., and Au, E. T. C.: Periampullary Carcinomas: Diagnosis and Surgical Management , S. Clin. North America 39:781, 1959. 3. Porter, M. R.: Carcinoma of the Pancreato-Duodenal Area: Operability and Choice of Procedure , Ann. Surg. 148:711, 1958.Crossref 4. Rhoads, J. E.; Zintel, H. A., and Helwig, J., Jr.: Results of Operations of the Whipple Type in Pancreatico-Duodenal Carcinoma , Ann. Surg. 146:661, 1957.Crossref 5. Kirtland, H. G., Jr.: A Safe Method of Pancreatic Biopsy , Am. J. Surg. 82:451, 1951.Crossref 6. Spjut, H. J., and Ramos, A. J.: An Evaluation of Biopsy-Frozen Section of the Ampullary Region and Pancreas: A Report of 68 Consecutive Patients , Ann. Surg. 146:925, 1957.Crossref 7. Bowden, L.: The Fallibility of Pancreatic Biopsy , Ann. Surg. 139:403, 1954.Crossref 8. Pipes, E., and Pareira, D.: Duodenal Obstruction Appearing After Palliative Biliary Diversion for Pancreatic Carcinoma , Surgery 44:636, 1958. 9. Zollinger, R. M., and Williams, R. D.: Surgical Aspects of Jaundice , Surgery 39:1016, 1956. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1960 American Medical Association. All Rights Reserved.
ISSN
0096-6908
DOI
10.1001/archsurg.1960.01290230110014
Publisher site
See Article on Publisher Site

Abstract

Abstract Relatively little attention has been given to factors affecting surgical morbidity and mortality in patients with obstructive jaundice due to malignancy. The indications for pancreaticoduodenectomy have received more attention; however, this procedure is possible in only 5% to 20% of cases.1-4 When only palliative procedures are possible the benefits of this surgery may be lost, owing to postoperative complications or death. These considerations have promoted a review of the clinical experiences with jaundice caused by malignancy. Hypotension leading to uremia has been found to be the most serious complication. Better preoperative preparation with blood volume replacement has been the only factor effective in decreasing the surgical mortality. Although the cure rate remains poor, the over-all survival has been improved through a lower operative mortality. The accuracy and dangers of biopsy, indications for gastroenterostomy at the time of surgery for inoperable lesions, and improvement in mortality rate will be discussed. References 1. Dennis, C., and Varco, R. L.: Survival for More Than Five Years After Pancreatoduodenectomy for Cancers of the Ampulla and Pancreatic Head , Surgery 39:92, 1957. 2. Cattell, R. B.; Warren, K. W., and Au, E. T. C.: Periampullary Carcinomas: Diagnosis and Surgical Management , S. Clin. North America 39:781, 1959. 3. Porter, M. R.: Carcinoma of the Pancreato-Duodenal Area: Operability and Choice of Procedure , Ann. Surg. 148:711, 1958.Crossref 4. Rhoads, J. E.; Zintel, H. A., and Helwig, J., Jr.: Results of Operations of the Whipple Type in Pancreatico-Duodenal Carcinoma , Ann. Surg. 146:661, 1957.Crossref 5. Kirtland, H. G., Jr.: A Safe Method of Pancreatic Biopsy , Am. J. Surg. 82:451, 1951.Crossref 6. Spjut, H. J., and Ramos, A. J.: An Evaluation of Biopsy-Frozen Section of the Ampullary Region and Pancreas: A Report of 68 Consecutive Patients , Ann. Surg. 146:925, 1957.Crossref 7. Bowden, L.: The Fallibility of Pancreatic Biopsy , Ann. Surg. 139:403, 1954.Crossref 8. Pipes, E., and Pareira, D.: Duodenal Obstruction Appearing After Palliative Biliary Diversion for Pancreatic Carcinoma , Surgery 44:636, 1958. 9. Zollinger, R. M., and Williams, R. D.: Surgical Aspects of Jaundice , Surgery 39:1016, 1956.

Journal

A.M.A. Archives SurgeryAmerican Medical Association

Published: Jun 1, 1960

References

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