[Indication of gastrojejunostomy in unresectable pancreatic cancer]

Up to 20% of patients with pancreatic carcinoma subjected to a bilio digestive diversion, develop a delayed gastric emptying due to duodenal infiltration. However the role of prophylactic gastrojejunoanastomosis is not well defined.

To compare the effects of gastrojejunoanastomosis performed as prophylaxis or as treatment for duodenal infiltration, in patients with unresectable pancreatic carcinoma.

Between 1983 and 1994, 44 gastrojejunoanastomosis were performed in patients with pancreatic carcinoma. In 24 patients the procedure was done as prophylaxis and in 20 as treatment of duodenal infiltration. Of these, three had been subjected previously to a bilio digestive diversion. Postoperative outcome and mortality of both groups of patients were compared.

Both groups of patients had similar sex and age. Operative morbidity and mortality were 33% and 0% in the group with the prophylactic procedure and 35 and 10% in the group with duodenal infiltration. Oral feeding was started 6.5 and 6.9 days after operation, and hospital stay was 10.7 and 11.4 days in either group. At the moment of the analysis, 95.5% of patients had died. Survival was significantly longer in the group with the prophylactic procedure (337.2 and 116.9 days respectively, p < 0.01). Thirty eight percent of patients required a further admission to the hospital, but only 4.8% due to gastric retention.

Gastrojejunoanastomosis is a good palliative procedure in patients with unresectable pancreatic carcinoma. It should be performed in every such patient who is subjected to a bilio digestive diversion and in whom a survival of some months can be predicted.