Role of prophylactic gastroenterostomy for unresectable pancreatic carcinoma

Methods of palliation and the use of prophylactic gastroenterostomy in the treatment of unresectable pancreatic carcinoma remain controversial. Gastroenterostomy has been linked with various complications. We conducted a 10-year (1982-1992) retrospective review of patients who had unresectable pancreatic carcinoma and underwent biliary decompression without prophylactic gastroenterostomy. 50 patients were studied. Only four patients (8%) developed duodenal obstruction and required reoperation for therapeutic gastroenterostomy. The mean time to obstruction was 15.75 months, whereas the mean overall survival was 12.99 months. The mean survival of patients who underwent therapeutic gastroenterostomy was 32.25 months, with an average palliation of 16.5 months after the second operation. We conclude that pancreatic carcinoma has a rapid natural progression, and most patients do not survive long enough to obstruct. The ones who do obstruct are unique in that they survive for a long period of time. We recommend that routine prophylactic gastroenterostomy is unnecessary, and selective use of gastroenterostomy should be exercised in case of present or impending duodenal obstruction.