Abstracts
2000 Digestive Disease Week

# 2316 Pain Management of Patients with Unresectable Periampullary Carcinoma.
Rutger C. I. Geenen, Claudia M. G. Dekker, Gertjan Tienhoven, Huug Obertop, Dirk J. Gouma, Amsterdam, Netherlands

Most patients (80-90%) with periampullary carcinoma are no candidate for resection and need palliative treatment of symptoms, such as jaundice, gastrointestinal obstruction and pain. Pain management is most commonly performed by analgesics or a coeliac plexus block. Reduction of pain has also been described after palliative radiotherapy for local tumor control. The aim of this study was to analyze the effects of these different treatment options for pain in patients who underwent a palliative surgical bypass for unresectable periampullary carcinoma. The records of 98 patients, who underwent a double bypass procedure (DBP) in the period between January 1995 and December 1998, were retrospectively reviewed. The patients were divided in three groups according to initial pain management. Group 1 (n=27) underwent DBP and pain management by medication, group 2 (n=47) underwent DBP in combination with a peroperative coeliac plexus block (PB) and group 3 (n=24) underwent DBP followed by high dose conformal radiotherapy (RT). The tumor stages of the groups were not comparable, because radiotherapy was not performed in patients with metastases but only in an attempt to achieve local tumor control. Metastases were present in respectively. 13/27(48%), 26/47(55%) and 0(0%) (p<0.01) patients. There was no significant difference in patients with pre-existing pain in the three groups respectively 15 (55%), 31 (66%) and 15 (63%). The pain medication-free survival period after surgery was respectively 3.2, 3.3 and 7.5 months (NS). In the subgroup of patients with pre-existing pain the pain medication-free survival was 3.2, 1.9 and 6.3 months (NS) and in patients without pre-existing pain respectively 3.3, 6.5 and 9.3 months (NS). Hospital-free survival was respectively 6.3, 6.8 and 10.3 months (p=0.01). It is concluded that the positive effect of coeliac block on pain from previous studies could not be confirmed and a suggested positive effect on survival in the subgroup with pre-existing pain and coeliac block was not found. The longest pain-medication-free survival and hospitalfree survival was found in patients treated with radiotherapy. This effect is probably mainly due to patient selection.