How is paliative surgery and endoscopy in pancreatic cancer?

Palliative Tx is needed in 85-90% of Pt Imp. QOL Prob : Pain , Jx , Duodenal Obstruction Pain : oral narcotic use  Celiac plexus n.block Jx : as previous slide Dudenal obstruction : Found 20% Prophylaxis Gastrojejunostomy : controversial Con : Anas. Leakage , delay Gastric emptying time Procedure : Antecolic , prefered than retrocolic 50 cm distance from Gastrojej. To Bilio-enteric anastomosis Dec. risk for Cholangitis , more easier if anastomosis leakage Gastrojej. Placed at most dependence part , greater Curvature Not do Vagotomy