A RATIONALE APPROACH TOWARD OPTIMAL PALLIATION USING ENDOSCOPIC ENDOPROSTHESES VERSUS OPERATIVE BYPASS IN OBSTRUCTIVE JAUNDICE BY ADVANCED PANCREATIC CANCER
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This study was conducted on a total of 82 patients who required palliative biliary decompression for obstructive jaundice due to unresectable cancer of the head of pancreas of the periampullary region. The patients were compared as regards survival time, early mortality, complication rates, hospitalization requirements after palliation by endoscopic endoprostheses or conventional surgical bypass. Patients within the two treatment groups were followed until their death. Patients treated with endoprostheses had a significantly shorter initial hospital stay than those treated surgically. Despite more frequent readmission to hospital fbr these patients treated endoscopically, their total time spent in hospital was still less, even though there was no statistical difference between the two treatment groups. The overall survival in the two groups was similar and the jaundice relieved in over 90% of patients. These patients were stratified for long (>6 months) and short (<6 months) survival times. In short-term survivors, the higher late morbidity rates after endoprostheses were offset by the higher early morbidity rates and longer initial hospital stay after the surgical bypass. In long-term survivors, there was also a highly significant increase in the late „morbidity after endoprostheses with no difference in early mortality and morbidity rates in either treatment group.