ANTRECTOMY - A SAFE AND EFFECTIVE BYPASS FOR UNRESECTABLE PANCREATIC-CANCER

Background: Pancreatic cancer is most often diagnosed too late for cur ative resection. Operative therapy, therefore, involves relief of bili ary obstruction and relief or prevention of gastric outlet obstruction . Previous studies show that gastrojejunostomy done either therapeutic ally or prophylactically often causes delayed gastric emptying. Object ive: To describe the results of antrectomy with Billroth II reconstruc tion (A/BII) as the palliative operation for gastric outlet obstructio n. Subjects: Fifty patients with unresectable pancreatic cancer underw ent A/BII without vagotomy from 1987 through 1993. Of these patients, 42 underwent simultaneous biliary bypass; six had undergone biliary by pass from 3 weeks to 34 months previously; and two with cancer origina ting in the uncinate process had no biliary bypass. Results: One 87-ye ar-old patient died on day 12 of azotemia and pulmonary insufficiency. The other 49 patients were discharged tolerating an oral diet an aver age of 11.3 days (range, 5 to 29 days) after A/BII. The length of stay following A/BII was not related to the extent of disease or to preope rative weight loss but was increased in older patients. Conclusion: Th e A/BII is a safe and effective bypass in patients with unresectable p ancreatic cancer.