Guidelines for the application of surgery and endoprostheses in the XXXX in @entity5 .

@entity1 @entity3883 @entity135 @entity5 @entity797
OBJECTIVE: This study was set up to identify @entity1 -related factors favoring the application of either surgery or endoprostheses in the @entity3883 in subsets of @entity1 with @entity135 or periampullary region. SUMMARY BACKGROUND DATA: In the @entity3883 , surgical biliodigestive anastomosis has traditionally been performed. Surgical biliary bypass is associated with high mortality (15% to 30%) and morbidity rates (20% to 60%) but little recurrent @entity3883 (0% to 15%). Biliary drainage with endoscopically placed endoprostheses has a lower complication rate, but recurrent @entity3883 is seen in up to 20% to 50% of @entity1 . METHODS: @entity1 with advanced @entity135 or periampullary region treated at the University Hospital Dijkzigt, Rotterdam, The Netherlands, between 1980 and 1990 were reviewed. In 148 @entity1 , data were compared concerning the morbidity and hospital stay after the @entity3883 with endoscopic endoprostheses or surgical biliary bypasses. These @entity1 were stratified for long (> 6 months) and short (< 6 months) survival times. RESULTS: In short-term survivors, the higher late morbidity rates after endoprostheses were offset by higher early morbidity rates and longer hospital stays after the surgical bypass. In long-term survivors, there was no difference in the hospital stay between the two groups, but the late morbidity rate was significantly higher in the endoprosthesis group. CONCLUSIONS: These data suggest that endoscopic endoprosthesis is the optimal palliation for @entity1 surviving less than 6 months and surgical biliary bypass for those surviving more than 6 months. This policy necessitates the development of prognostic criteria, which were obtained by @entity797 proportional-hazards survival analysis. Advanced age, male sex, liver metastases, and large diameters of @entity5 were unfavorable prognostic factors. With these factors, the risk of short- or long-term survival can be predicted. It is hoped that the application of these data may allow a rational approach toward optimal palliative treatment of this form of @entity3883 .
