The Need for a Prophylactic Gastrojejunostomy for Unresectable Periampullary Cancer

Heek, N. Tjarda van; Castro, S. M. M. de; Eijck, Casper H. van; Geenen, Rutger C. I. van; Hesselink, E. J.; Breslau, Paul J.; Tran, Thien; Kazemier, Geert; Visser, Margreet; Busch, Olivier R.; Obertop, H.; Gouma, Dirk J.

doi:10.1097/01.sla.0000098617.21801.95

Cited by 170 publications

(41 citation statements)

References 48 publications

(47 reference statements)

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“…A randomized trial performed in the Academic Medical Center between 1999 and 2002 shows comparable results [21]. In this study, 21% of the patients needed reoperation after hepaticojejunostomy because of late gastrointestinal obstruction.…”

Section: Discussionsupporting

confidence: 52%

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POSSUM Predicts Survival in Patients with Unresectable Pancreatic Cancer

Castro¹,

Houwert²,

Lagard³

et al. 2009

Dig Surg

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Background: The aim of this study was to evaluate the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) for patients with unresectable pancreatic cancer and to analyze whether POSSUM can predict the long-term outcome in these patients. Such a scoring system could be useful to aid in the decision between surgical and endoscopic palliation. Methods: Between January 1993 and December 2004, 241 patients were found to have unresectable pancreatic cancer during exploratory laparotomy and underwent a double bypass procedure consisting of a gastrojejunostomy and a hepaticojejunostomy. Results: Overall, 64 of 240 patients (27%) had one or more complications after bypass surgery and 4 patients (2%) died. POSSUM predicted morbidity in 114 patients (47%). The observed:predicted (O:P) ratio for morbidity was 0.56 and the model had a significant lack of fit (p < 0.001) using a goodness-of-fit analysis. The overall median survival was 7 months. The POSSUM scoring system was, however, an independent predictor of survival in multivariate analysis. Conclusions: Overall, POSSUM overpredicted morbidity but was an independent predictor of survival.

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Section: Discussionsupporting

confidence: 52%

“…Distant metastases were defined as histologically proven metastases in the liver or in lymph nodes outside the resection specimen (N3). A few patients only received a hepaticojejunostomy as part of a prospective trial [21]. Cholecystectomy and chemical splanchnicectomy with 50% ethanol were routinely performed.…”

Section: Methodsmentioning

confidence: 99%

POSSUM Predicts Survival in Patients with Unresectable Pancreatic Cancer

Castro¹,

Houwert²,

Lagard³

et al. 2009

Dig Surg

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“…Other investigators have reported similar difficulties. A randomized trial29 examining QoL in patients with unresectable periampullary tumours with or without prophylactic gastrojejunostomy reported a compliance rate of 90 per cent in the first 4 months of follow‐up, but it decreased to 75 per cent in the final 2 months of the study. Likewise, another randomized trial30 comparing stenting with surgical bypass for malignant gastric outlet obstruction reported a compliance rate of 57 per cent with follow‐up surveys at 1 month.…”

Section: Discussionmentioning

confidence: 99%

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Fujitani¹,

Ando

Sakamaki

et al. 2017

BJS Open

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BackgroundQuality of life (QoL) is a key component in decision‐making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer.MethodsThe study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ‐5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ‐STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.ResultsSome 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ‐5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric‐specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien–Dindo classification was 9·6 per cent (10 patients) and the 30‐day postoperative mortality rate was 1·9 per cent (2 patients).ConclusionIn patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).

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“…In the AMC every patient with locally advanced disease underwent a double bypass in a trial setting [28, 29]. In the EMC only patients with signs of obstruction peri- and postoperatively underwent a bypass.…”

Section: Discussionmentioning

confidence: 99%

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

Smeenk

Castro²,

Jeekel³

et al. 2005

Dig Surg

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Aim of the Study: In two institutions, a retrospective analysis was performed on patients with histologically proven locally advanced pancreatic cancer without distant metastases. The aim of this analysis is to assess whether chemoradiotherapy provides survival benefit for patients with locally advanced pancreatic cancer. Methods: Forty-five patients from the Erasmus Medical Centre (Erasmus MC), Rotterdam, received 5-fluorouracil (5-FU) and radiotherapy and, 38 patients from the Academic Medical Centre Amsterdam (AMC) were offered the best supportive care. Radiotherapy consisted of 50 Gy external upper abdomen radiation in two courses, concomitant with intravenous 5-FU 25 mg/kg/ 24 h continuously on the first 4 days of each treatment course. Results: The treatment protocol was completed in 38 of 45 patients (84%) without complications. Radiological response was evaluated in 38 patients. Ten patients (26%) showed a partial response, stable disease was seen in 6 (16%) patients and progressive disease in 22 (58%) patients. A second-look operation was performed in 8 of 10 patients (72%) showing a radiological response, in 3 patients the tumour could be resected. Median overall survival time for the Erasmus MC group (n = 45) was 9.8 months compared to 7.6 months when the best supportive care was given (AMC group, p = 0.04). Conclusion: Although overall survival remains poor, treatment with 5-FU and radiotherapy might benefit some patients with locally advanced pancreatic cancer.

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The Need for a Prophylactic Gastrojejunostomy for Unresectable Periampullary Cancer

Cited by 170 publications

References 48 publications

POSSUM Predicts Survival in Patients with Unresectable Pancreatic Cancer

POSSUM Predicts Survival in Patients with Unresectable Pancreatic Cancer

Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Locally Advanced Pancreatic Cancer Treated with Radiation and 5-Fluorouracil: A First Step to Neoadjuvant Treatment?

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