A comparison of cholecysto- and choledochoenterostomy for obstructing pancreatic cancer

This report compares the efficacy of cholecystoenterostomy and choledochoenterostomy for relief of biliary obstruction due to pancreatic cancer. From 1976 to 1988, 109 biliary enteric bypass procedures were performed on patients with pancreatic carcinoma considered unresectable at exploration. Sixty-four of these patients underwent cholecystoenteric anastomosis (CCEA) and 45 choledochoenteric anastomosis (CDEA). Thirty-day operative mortality was 6.3 per cent for CCEA and 8.8 per cent for CDEA; the mean length of survival after operation was 7.8 months for CCEA and 8.9 months for CDEA. Of the 64 patients who underwent CCEA, all but two experienced short-term (greater than 60 days) relief of jaundice and pruritus. These patients were found to have an obstructed cystic duct and a cholecystectomy and choledochojejunostomy were performed. Five other patients in the CCEA group had recurrence of jaundice for an overall failure rate of 10.9 per cent. Operative morbidity in this group was 14 per cent. One of the patients in the CDEA group had an early recurrence of jaundice and three others experienced late recurrence, for an overall failure rate of 8.8 per cent. Operative morbidity in this group was 16 per cent. We conclude that these procedures have comparable morbidity and mortality. Although a few patients with cholecystoenteric anastomosis will develop recurrent jaundice, the simplicity of the procedure, the shorter operative time, and the equivalent relief of symptoms make it a useful procedure and one we believe preferable in high-risk patients.