Laparoscopic gastrojejunostomy for gastric outlet obstruction in pancreatic cancer

Up to 20 per cent of patients with pancreatic cancer develop gastric outlet obstruction. Traditionally, these patients have been managed with an open gastrojejunostomy. Laparoscopic gastrojejunostomy may now be a preferable approach. We conducted a retrospective review of nine patients who underwent laparoscopic gastrojejunostomy in 2001-2004. All nine patients had unresectable pancreatic cancer. There were six men and three women. Median age was 66 years (range 36-87). Two patients had prior laparotomies for attempted resection. Four patients had previously placed duodenal stents that failed. Four others had undergone unsuccessful attempts of duodenal stenting. Median operating time was 116 minutes (range 75-300). There were no intraoperative complications or conversions to open procedure. Median time to postoperative oral intake was 4 days (range 3-6), and median postoperative length of stay was 7 days (range 5-18). Eight of our nine patients were palliated successfully using this technique. There were no complications or deaths related to the operation. All patients were discharged from the hospital. Six patients have since died, with a median postoperative survival of 2.5 months (range 1.5-8). Laparoscopic gastrojejunostomy provides safe and effective palliation of gastric outlet obstruction in patients with unresectable pancreatic cancer. This approach allows for rapid palliation in a group of patients with a very limited survival.