ABSTRACT

Palliative surgery is usually employed in periampullary cancers since the cases where radical surgical management could be possible constitute only the minority. Because of being safe and easily applicable, transtumoral stent application provides an optimal treatment strategy as an alternative to the traditional bypass surgery. Despite studies which demonstrate that stent application into biliary channels should be as succesful as surgery, this comparison was not investigated by evaluating parameters such as survival, complications, life quality, costs, different palliation procedures and hospitalization time. To establish such a comparison, 53 patients with unresectable periampullary cancer who had been treated in our clinic with surgical and nonsurgical treatment modalities were evaluated retrospectively. The patients were divided in two groups regarding to the employed treatment modality either surgically (37 patients) or nonsurgically (16 patients). Both groups were compared in regard to complication rate, postoperative hospitalization time, necessity of repeat intervention and survival. The statistical analysis was made by GraphPad Prisma V.3 package program. Univariated variance analysis in the comparison between main groups, independent t-test between dual groups, and chi-square test between qualitative values were used. Overall survival and survival of operation methods were evaluated with Kaplan Meier and Log rank tests. The mean age in males and females were 62,53±10,81 years and 62,81±16,65 years, respectively. While the morbidity rate (24,3% versus 12,5%) and survival (7±1 months versus 5±1 months) were higher in the surgical group, there were no statistically significiant differences between the groups. While there was a small benefit in regard to necessity of repeat intervention in favour of surgery group, there was a benefit in regard to hospitalization time in the nonsurgical group, however these differences did not reach the level of the statistical difference (P>0,05). In conclusion; despite morbidity rates and hospitalization time are higher, the recurrence risk of jaundice is lower in surgical palliation methods. Nonsurgical palliation interventions seem to be more advantageous in patients with low life expectancy or in patients with high surgical risks because of concomitant diseases, whereas surgical palliation procedures are for patients with longer life expectancy with locally advanced diseases and with patients in whom an unresectable tumor is detected during surgery.

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