Palliative treatment for unresectable periampullary cancer is directed at three major symptoms: obstructive jaundice, duodenal obstruction, and cancer-related pain. In most cases, the pattern of symptoms at the time of diagnosis in the context of the patient's medical condition and projected survival influence the decision to perform an operative versus a nonoperative palliative procedure. Despite improvements in preoperative imaging and laparoscopic staging of patients with periampullary cancer and hilar cholangiocarcinoma, surgical exploration is the only modality that can definitively rule out resectability and the potential for curative resection in some patients with nonmetastatic cancer. Furthermore, only surgical management achieves successful palliation of obstructive symptoms and cancer-related pain as a single procedure during exploration. To take advantage of the long-term advantages afforded by surgical palliation, operative procedures must be performed with acceptable morbidity. The average postoperative length of hospital stay for patients who undergo surgical palliation is less than 15 days, even in those who develop minor complications. The average survival of patients who receive surgical palliation alone for nonmetastatic, unresectable pancreatic cancer is approximately 8 months. As with all treatment planning, palliative therapy for pancreatic and biliary cancer should be planned using a multidisciplinary approach, including input from the surgeon, gastroenterologist, radiologist, and medical and radiation oncologist. In this way, quality of life can be optimized in most patients with these diseases.
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