Is there a place for gastroenterostomy in patients with advanced cancer of the head of the pancreas?

Abstract

There remains doubt about the need for gastroenterostomy in patients with advanced cancer of the pancreatic head, performed either prophylactically or when passage of food becomes impossible. The records of 142 patients admitted for advanced pancreatic cancer to the Erasmus University Hospital over a period of 11 years were reviewed. We concentrated especially on the pre- and postoperative intake of food in cases involving gastroenterostomy and the morbidity and mortality associated with abdominal surgery in these patients. Of 129 patients without symptoms of gastric outlet obstruction at the time of diagnosis, 31 underwent prophylactic gastroenterostomy. The procedure did not prevent gastric outlet obstruction in 4 patients. Of the remaining 98 patients, 15 developed gastric outlet obstruction. Cox proportional hazards analysis showed no significant difference in the interval to the occurrence of a symptomatic obstruction between these two groups, taking into account other covariables. Postoperative complications and mortality regarding a gastroenterostomy were high, ranging from 9% to 41% and 11% to 33%, respectively. Our results do not indicate that prophylactic gastroenterostomy may significantly prevent future gastric outlet obstruction; therefore, as it also increases morbidity, it should not be performed. A gastroenterostomy to relieve symptoms should be considered carefully, as the success rate is low and is accompanied by a considerable incidence of morbidity and mortality.

Malignant gastrointestinal obstruction: endoscopic stenting versus surgical palliation

“…The traditional palliative treatment for these patients has been open gastrojejunostomy. However, the high rate of associated morbidity and mortality (10%) [15,17], has led to the study of alternative treatments aimed at improving these results and the quality of life for the patients.…”

“…Traditionally, this treatment has been performed through open gastrojejunostomy that has been associated with considerable morbidity in a weakened group of patients with a short life expectancy [15,17]. Over the past 10 years, various series have demonstrated the efficiency and safety of endoscopic treatment for these patients though the placement of metallic stents [3,5,6,11,14].…”

Medical Management of Pancreatic Adenocarcinoma

“…Although routine prophylactic gastrojejunostomy for operative palliation of pancreatic cancer has been proposed by many authors [102,103] , it has been contested by others due to the high incidence of postoperative delayed gastric emptying (DGE) [104] . Some reports show an incidence of DGE after duodenum bypass surgery ranging from 24 to 29% [104,105] . We described the occurrence of postoperative DGE in 28.2% of patients with unresectable pancreatic cancer submitted to prophylactic gastric bypass [106] .…”

Gastric outlet obstruction secondary to pancreatic cancer

“…A gastrojejunostomy was usually performed. However, palliative surgical bypass carries with it a high risk of morbidity and mortality [15,18]. Not only do patients often spend a great deal of time in hospital recovering from surgery, but the 30-day mortality rate in these patients has been reported to be 70% [18].…”