Gastroenterostomy in patients with irresectable periampullary carcinoma

Introduction. Gastric outlet obstruction is the second main symptom after jaundice in patients with pancreatic carcinoma. With regard to gastroduodenal obstruction surgical gastroenterostomy has been the standard treatment approach in advanced periampullary tumors cases. The decision to perform a prophylactic gastroenterostomy in patients without obvious gastroduodenal patency disturbance remains unresolved. Purpose of the study - to evaluate surgical palliation in patients with gastric outlet obstruction caused by pancreatic carcinoma. Materials and Methods. Patients who received surgical palliation for unresectable pancreatic cancer were divided into two groups according to their operative procedure. A comparative analysis was made regarding performed gastroenterostomy. Prophylactic gastroenterostomy was applied when performed choledochoduodenostomy and gallbladder to stomach bypass. Results. Roentgenoscopy of a stomach allows receiving accurate information as to gastroduodenal patency disturbance. In the main group (n = 98) performed 25 (26 %) gastroenterostomy, including 8 prophylactic, in the comparison group (n = 132) - 15 (11,7 %), p = 0,009. Morbidity and mortality rates in main and comparison groups were comparable: 22,9 % vs 24,2 %, p = 0,95 and 10,4 % vs 12,5 %, p = 0,78 respectively. In the remote period 1 (1,0 %) patient in the main group and 4 (3,0 %) patients in the comparison group were undergone bypass surgery for late gastric outlet obstruction (p = 0,56). Three patients of them in the comparison group were admitted with cholangitis. Discussion and Conclusions. Indications for duodenal bypass should be based on radiological signs of duodenal patency disturbance. The possibility of X-ray control barium passage instead of routine roentgenoscopy of a stomach is shown. Prophylactic gastroenterostomy when performed choledochoduodeno- and cholecystogastrostomy substantially reduces risk of late reflux-cholangitis.