An analysis of cost and clinical outcome in palliation for advanced pancreatic cancer

The optimal palliative method for patients with unresectable pancreatic cancer remains controversial. A retrospective chart review evaluated patients who underwent exploration for presumed resectable pancreatic cancer. Cost-based analysis was performed using relative value units (RVUs) that included the initial surgical procedure and any additional procedure required to achieve satisfactory palliation. Of 96 patients (1993–2002), 6% had biliary bypass, 42% had duodenal bypass, 40% had double bypass, and 13% had no procedure with equivalent clinical outcomes. If biliary bypass was not initially performed, there was a significant incidence of biliary complications before definitive endoscopic stenting ( P = .01). If duodenal bypass was not initially performed, 11% developed duodenal obstruction ( P = .04). Total RVUs was highest for a double bypass and lowest for no initial surgical palliative procedure. Although surgical bypass procedures at initial exploration provide durable palliation, these procedures are associated with greater costs.