Surgical Palliation for Pancreatic Malignancy: Practice Patterns and Predictors of Morbidity and Mortality

Most patients with pancreatic cancer present with, or develop, biliary or duodenal obstruction. We sought to characterize palliative surgery utilization in a contemporary cohort and identify patients at high risk of morbidity and mortality. The ACS NSQIP database (2005-2011) was queried for patients with a pancreatic malignancy undergoing gastrojejunostomy, biliary bypass, or laparotomy without resection. Univariate analysis and multivariate logistic regression identified factors associated with increased risk of 30-day morbidity or mortality. Operations for the 1,126 patients undergoing palliative bypass were gastrojejunostomy alone (33 %), bile duct bypass alone (27 %), both (31 %), or cholecystojejunostomy (9 %). A major complication occurred in 20 % and mortality in 6.5 % at 30 days. Risk factors for morbidity and mortality were defined in multivariate models. The number of identified risk factors stratified morbidity from 14.8-50 % and mortality from 1.6-50 % (p < 0.0001 for each). Laparotomy alone (n = 622) was associated with lower morbidity than bypass (12 vs. 20 %, p < 0.0001), but equivalent mortality (5 vs. 6.5 %, p = 0.21). Palliative bypass for pancreatic cancer is associated with a high rate of morbidity and mortality. In select patients, this risk may be prohibitive. Patient selection reflecting predictors of morbidity and mortality may allow for improved outcomes.