Stomach-preserving gastric bypass for unresectable pancreatic cancer

From 1992 to 1995, we treated 25 patients who had unresectable pancreatic cancer with a stomach-preserving gastric bypass (SPGB). After as much of the stomach as possible was preserved, it was bypassed to the jejunum by end-to-side anastomosis. During the same period, five patients underwent other types of bypasses while 47 similar patients did not undergo gastric bypass. Although the mean operative time for SPGB was significantly longer than for other types of bypass, the mean intraoperative blood loss was similar. Operative morbidity with SPGB was 28%, and there were no operative deaths. In patients undergoing SPGB, the incidence of delayed gastric emptying was high (24%), but the comfort index (ratio of duration of good palliation to duration of survival) exceeded 50% when metastases were either regional or systemic but limited. The comfort index of patients undergoing other types of bypass or not undergoing bypass was less than 40%. However, the patients with extensive systemic metastases survived less than 100 days and the comfort index was less than 30% for all treatment groups. Our results thus suggest that SPGB is safe and effective for patients with either regional metastases or limited systemic metastases.