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Palliative Surgery in Pancreatic Head Cancer at the University Hospital of Bouaké

Received: 9 January 2022     Accepted: 4 February 2022     Published: 16 February 2022
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Abstract

Introduction: Cancer of the head of the pancreas is increasing in incidence. It represents 3% of all cancers and 20% of digestive cancers. Diagnosis is most often late. Indeed, 80% of these cancers are discovered at an advanced stage. In this case, the treatment is essentially palliative. The reference treatment is chemotherapy associated with endoscopic treatment if there is obstruction of the bile duct. Palliative surgery is only indicated in the case of intraoperative discovery of a contraindication to a curative surgical procedure. However, this palliative surgery is still in the forefront in low-income countries with limited technical facilities. The aim of this work was to determine the frequency and modalities of palliative surgery in unresectable pancreatic head cancer and to evaluate the results. Methods: Retrospective and descriptive study of the files of patients who underwent palliative surgery for a malignant tumour of the head of the pancreas; operated at the University Hospital of Bouake from January 2011 to December 2020. Results: Palliative surgery was performed in 71 patients, or 80.6% of patients with locally advanced pancreatic head tumour. We performed a double biliary and digestive bypass systematically. The digestive bypass was a gastrojejunal anastomosis in all cases. For the biliary-digestive diversion, different modalities were performed, notably a choledocho-jejunal anastomosis in 53.6% (n=38), a cholecysto-jejunal anastomosis in 38.0% (n=27) and a choledochodenal anastomosis in 8.4% (n=6). The overall morbidity was 22.5% (n=16). Morbidity related to the surgical procedure was 18.3% (n=13). These were biliary leakage (n=6; 8.4%) and parietal bleeding (n=4; 5.6%). Three patients died immediately postoperatively, giving an operative mortality of 4.2%. The mean survival of the patients was 5.8±2.2 months. Conclusion: Palliative surgery occupies a privileged place in our practice, allowing an improvement in the quality of life of the patients without apparent influence on the long-term prognosis which remains appalling. The hope of improving the prognosis lies in early diagnosis and strengthening the technical platform.

Published in Journal of Surgery (Volume 10, Issue 1)
DOI 10.11648/j.js.20221001.17
Page(s) 34-39
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Biliary Bypass, Palliative Surgery, Pancreatic Cancer

References
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[2] Ferlay J, Partensky C, Bray F. More deaths from pancreatic cancer than breast cancer in the EU by 2017. Acta Oncol 2016; 55 (9-10): 1158-60.
[3] Deflandre LA, Loly JP, Leclercq P, Loly C, Louis E, Gast P. Adénocarcinome obstructif localement avancé de la tête du pancréas: importance du drainage biliaire précoce. [Locally advanced obstructive adenocarcinoma of the pancreatic head: importance of early biliary drainage] Rev Med Suisse 2018; 14: 1443-7.
[4] Cronin FDP, Erichsen R, Mortensen D, Norgaard J. Pancreatic cancer survival in central and northern Denamark from 1998 through 2009: a Population based cohort study. Clinical epidemiology 2011; 3 (suppl): 19-25.
[5] Kamangar F, Dores GM, Anderson WF. Patterns of cancer incidence, mortality, and prevalence across five continents: Defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 2006; 24 (14): 2137-50.
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[7] Sidibé BY, Dembélé BT, Bah A, Maiga A, Coulibaly A, Traoré A et Al. Dérivations bilio-digestives dans la chirurgie palliative du cancer de la tête du pancréas au CHU Gabriel Touré. [Bilio-digestive diversions in palliative surgery for pancreatic head cancer at Gabriel Touré University Hospital.] Mali médical 2018; 33 (3): 29-32.
[8] Berrada S, D’khissy M, Ridai M, Zerouali NO. Place de la dérivation bilio-digestive dans le traitement du cancer de la tête du pancréas. [Place of biliary-digestive bypass in the treatment of pancreatic head cancer] Médecine du Maghreb 1993 n°37.
[9] Neuzillet C, Gaujoux S, Williet N, Bachet JB, Bauguion L, Colson DL, et Al. Thésaurus National de Cancérologie Digestive (TNCD); Dig Liver Dis. 2018; 50 (12): 1257-71.
[10] Maire F, Sauvanet A. Dérivations biliaires et digestives pour tumeur pancréatique non résécable: endoscopie ou chirurgie? [Biliary and digestive diversions for unresectable pancreatic tumour: endoscopy or surgery?]. J Chir Visc 2013; 150: 28-32.
[11] Souaibou YI, Gnangnon FHR, Seto DM, Lawani I, Attolou GR, N'Tcha NHN et Al. Chirurgie palliative de présumes cancers de la tête du pancréas: notre expérience au CNHU-HKM de Cotonou (Benin). [Palliative surgery of presumed pancreatic head cancers: our experience at the CNHU-HKM of Cotonou (Benin)]. J Afr Chir Digest 2018; 18 (1): 2354-8.
[12] Sacko O, Sanogo ZZ, Camara A, Koumaré S, Koïta A, Keïta S et Al. Dérivations bilio-digestives dans la chirurgie palliative du cancer de la tête du pancréas: à propos de 45 cas. [Bilio-digestive diversions in palliative surgery for pancreatic head cancer: a review of 45 cases.]. Rev. Afr. Chir. Spéc. 2012; 003: 35-40.
[13] Tchangai B, Tchaou M, Darre T, Alassani F, Dosseh ED, Attipou K. Indications et résultats de la chirurgie palliative des cancers de la tête du pancréas au CHU Sylvanus Olympio. [Indications and results of palliative surgery for pancreatic head cancers at Sylvanus Olympio University Hospital]. RECAC. 2017; 2 (13): 41-4.
[14] Maire F, Hammel P, Ponsot P. Long-term outcome of biliary and duodenal stents in palliative treatment of patients with unresectable adenocarcinoma of the head of pancreas. Am J Gastroenterol 2006; 101: 735-42.
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Cite This Article
  • APA Style

    Mamadou Traore, Bernadette Ahou N’Dri, Ibrahim Kouakou Anzoua, Bernadin Kouame Kouakou, Ismael Kalou Leh Bi, et al. (2022). Palliative Surgery in Pancreatic Head Cancer at the University Hospital of Bouaké. Journal of Surgery, 10(1), 34-39. https://doi.org/10.11648/j.js.20221001.17

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    ACS Style

    Mamadou Traore; Bernadette Ahou N’Dri; Ibrahim Kouakou Anzoua; Bernadin Kouame Kouakou; Ismael Kalou Leh Bi, et al. Palliative Surgery in Pancreatic Head Cancer at the University Hospital of Bouaké. J. Surg. 2022, 10(1), 34-39. doi: 10.11648/j.js.20221001.17

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    AMA Style

    Mamadou Traore, Bernadette Ahou N’Dri, Ibrahim Kouakou Anzoua, Bernadin Kouame Kouakou, Ismael Kalou Leh Bi, et al. Palliative Surgery in Pancreatic Head Cancer at the University Hospital of Bouaké. J Surg. 2022;10(1):34-39. doi: 10.11648/j.js.20221001.17

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  • @article{10.11648/j.js.20221001.17,
      author = {Mamadou Traore and Bernadette Ahou N’Dri and Ibrahim Kouakou Anzoua and Bernadin Kouame Kouakou and Ismael Kalou Leh Bi and Amos Serge Ekra and Amos Blaise Kouakou and Alassane Binate and Venance Alloka and Inza Bamba and Ezechiel Akowendo and Roger Lebeau and Bamourou Diane},
      title = {Palliative Surgery in Pancreatic Head Cancer at the University Hospital of Bouaké},
      journal = {Journal of Surgery},
      volume = {10},
      number = {1},
      pages = {34-39},
      doi = {10.11648/j.js.20221001.17},
      url = {https://doi.org/10.11648/j.js.20221001.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20221001.17},
      abstract = {Introduction: Cancer of the head of the pancreas is increasing in incidence. It represents 3% of all cancers and 20% of digestive cancers. Diagnosis is most often late. Indeed, 80% of these cancers are discovered at an advanced stage. In this case, the treatment is essentially palliative. The reference treatment is chemotherapy associated with endoscopic treatment if there is obstruction of the bile duct. Palliative surgery is only indicated in the case of intraoperative discovery of a contraindication to a curative surgical procedure. However, this palliative surgery is still in the forefront in low-income countries with limited technical facilities. The aim of this work was to determine the frequency and modalities of palliative surgery in unresectable pancreatic head cancer and to evaluate the results. Methods: Retrospective and descriptive study of the files of patients who underwent palliative surgery for a malignant tumour of the head of the pancreas; operated at the University Hospital of Bouake from January 2011 to December 2020. Results: Palliative surgery was performed in 71 patients, or 80.6% of patients with locally advanced pancreatic head tumour. We performed a double biliary and digestive bypass systematically. The digestive bypass was a gastrojejunal anastomosis in all cases. For the biliary-digestive diversion, different modalities were performed, notably a choledocho-jejunal anastomosis in 53.6% (n=38), a cholecysto-jejunal anastomosis in 38.0% (n=27) and a choledochodenal anastomosis in 8.4% (n=6). The overall morbidity was 22.5% (n=16). Morbidity related to the surgical procedure was 18.3% (n=13). These were biliary leakage (n=6; 8.4%) and parietal bleeding (n=4; 5.6%). Three patients died immediately postoperatively, giving an operative mortality of 4.2%. The mean survival of the patients was 5.8±2.2 months. Conclusion: Palliative surgery occupies a privileged place in our practice, allowing an improvement in the quality of life of the patients without apparent influence on the long-term prognosis which remains appalling. The hope of improving the prognosis lies in early diagnosis and strengthening the technical platform.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Palliative Surgery in Pancreatic Head Cancer at the University Hospital of Bouaké
    AU  - Mamadou Traore
    AU  - Bernadette Ahou N’Dri
    AU  - Ibrahim Kouakou Anzoua
    AU  - Bernadin Kouame Kouakou
    AU  - Ismael Kalou Leh Bi
    AU  - Amos Serge Ekra
    AU  - Amos Blaise Kouakou
    AU  - Alassane Binate
    AU  - Venance Alloka
    AU  - Inza Bamba
    AU  - Ezechiel Akowendo
    AU  - Roger Lebeau
    AU  - Bamourou Diane
    Y1  - 2022/02/16
    PY  - 2022
    N1  - https://doi.org/10.11648/j.js.20221001.17
    DO  - 10.11648/j.js.20221001.17
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 34
    EP  - 39
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20221001.17
    AB  - Introduction: Cancer of the head of the pancreas is increasing in incidence. It represents 3% of all cancers and 20% of digestive cancers. Diagnosis is most often late. Indeed, 80% of these cancers are discovered at an advanced stage. In this case, the treatment is essentially palliative. The reference treatment is chemotherapy associated with endoscopic treatment if there is obstruction of the bile duct. Palliative surgery is only indicated in the case of intraoperative discovery of a contraindication to a curative surgical procedure. However, this palliative surgery is still in the forefront in low-income countries with limited technical facilities. The aim of this work was to determine the frequency and modalities of palliative surgery in unresectable pancreatic head cancer and to evaluate the results. Methods: Retrospective and descriptive study of the files of patients who underwent palliative surgery for a malignant tumour of the head of the pancreas; operated at the University Hospital of Bouake from January 2011 to December 2020. Results: Palliative surgery was performed in 71 patients, or 80.6% of patients with locally advanced pancreatic head tumour. We performed a double biliary and digestive bypass systematically. The digestive bypass was a gastrojejunal anastomosis in all cases. For the biliary-digestive diversion, different modalities were performed, notably a choledocho-jejunal anastomosis in 53.6% (n=38), a cholecysto-jejunal anastomosis in 38.0% (n=27) and a choledochodenal anastomosis in 8.4% (n=6). The overall morbidity was 22.5% (n=16). Morbidity related to the surgical procedure was 18.3% (n=13). These were biliary leakage (n=6; 8.4%) and parietal bleeding (n=4; 5.6%). Three patients died immediately postoperatively, giving an operative mortality of 4.2%. The mean survival of the patients was 5.8±2.2 months. Conclusion: Palliative surgery occupies a privileged place in our practice, allowing an improvement in the quality of life of the patients without apparent influence on the long-term prognosis which remains appalling. The hope of improving the prognosis lies in early diagnosis and strengthening the technical platform.
    VL  - 10
    IS  - 1
    ER  - 

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Author Information
  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

  • Department of General and Digestive Surgery, University Hospital of Bouake, Bouake, Ivory Coast

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