Healthcare Professionals

Non-operative procedures prior to definitive treatment

Patients with locally advanced pancreatic cancer usually present with obstructive jaundice. If it is not relived it leads to progressive liver dysfunction, hepatic failure and early death. Different techniques are used for palliation in patients who cannot be surgically treated.

Endoscopic biliary stent insertion is an option. Early complications of endoscopic stenting are cholangitis, pancreatitis, bleeding and bile duct or duodenal perforation. Late complications are stent occlusion, cholecystitis and stent migration.

In cases where stent placement cannot be done, percutaneous transhepatic biliary drainage (PTBD) is performed. Either an internal-external catheter is placed and maintained or a totally indwelling endoprosthesis is percutaneously positioned. Complications include stent occlusion, bile peritonitis, cholangitis, pancreatitis, acute cholecystitis, bile pleural effusion and hemobilia related to the transhepatic route.

The management of pain is difficult and pain is poorly controlled in patients with pancreatic cancer. The WHO three step analgesic ladder is used for pain relief. Long acting oral analgesics or topical analgesics worn as continuous release patches are generally used. If the pain is not well controlled then some invasive techniques like endoscopic celiac plexus block or external beam radiation therapy (EBRT) is considered.

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