Unresectable pancreatic cancer: what is the optimal procedure?

We retrospectively reviewed cases of pancreatic cancer to determine the benefit of various methods of biliary decompression and the role of prophylactic gastroenterostomy (GE) in management. Twenty-seven patients had only biliary bypass, and 26 had biliary bypass and GE. Operative mortality was similar for both groups (22% and 19%, respectively). The complication rates were almost identical (37% and 35%). Differences in operative mortality, incidence of cholangitis, and recurrence of jaundice were not statistically significant between patients having biliary decompression via the common bile duct or the gallbladder. Operative mortality associated with choledochoenterostomy was 33% versus 17% for cholecystoenterostomy. Gastric outlet obstruction developed in 5% of patients who did not have GE. We conclude that cholecystojejunostomy is an effective method of biliary bypass. Because its addition did not seem to increase operative morbidity or mortality, we advocate GE at the initial exploration to prevent gastric outlet obstruction.