Palliative operations for pancreatic cancer in the hospitals of the U.S. Department of Veterans Affairs from 1987 to 1991

A total of 1,180 patients underwent palliative surgery for pancreatic cancer in the 158 hospitals of the U.S. Department of Veterans Affairs from 1987 to 1991. Using computerized data files, we analyzed these procedures according to type of procedure (gastric bypass only [GO], biliary bypass only [BO], or combined biliary and gastric bypass [BG]), survival, reoperation and complication rates, patient age, and operative (30-day) mortality. Survival after GO (208 days) was significantly shorter than after BO or BG (279 days and 259 days, respectively; p≤0.05 by analysis of variance). The reoperation rate after BO (12%) was higher than after BG (5%; p≤0.001 by χ² analysis) and was due to the higher incidence of reoperative gastric bypass in the BO group. Complication rates were similar after all bypass types. Reoperations had a 25% 30-day mortality. The 32 gastric bypasses performed after an initial BO were done at a mean of 193 days after the original BO bypass, whereas other reoperations were undertaken at a mean of 73 days after the first operation. This first national study of palliative operations for pancreatic cancer supports combined biliary/gastric bypass as the initial procedure, thus minimizing reoperations and their attendant morbidity.