Indication of gastrojejunostomy in patients with unresectable pancreatic carcinoma

Background: Up to 20% of patients with pancreatic carcinoma subjected to a bilio digestive diversion, develop a delayed gastric emptying due to duoden al infiltration. However the role of prophylactic gastrojejunoanastomosis i s not well defined. Aim: To compare the effects of gastrojejunoanastomosis performed as prophylaxis or as treatment for duodenal infiltration, in pati ents with unresectable pancreatic carcinoma. Patients and methods: Between 1983 and 1994, 44 gastrojejunoanastomosis were performed in patients with p ancreatic carcinoma. In 24 patients the procedure was done as prophylaxis a nd in 20 as treatment of duodenal infiltration. Of these, three had been su bjected previously to a bilio digestive diversion. Postoperative outcome an d mortality of both groups of patients were compared. Results: both groups of patient had similar sex and age. Operative morbidity and mortality were 33% and 0% in the group wit the prophylactic procedure adn 35 and 10% in th e group with duodenal infiltration. Oral feeding was started 6.5 and 6.9 da ys after operation, and hospital stay was 10.7 and 11.4 days in either grou p. At the moment of the analysis, 95.5% of patients had died. Survival was significantly longer in the group with the prophylactic procedure (337.2 an d 116.9 days respectively, p < 0.01). Thirty eight percent of patients requ ired a further admission to the hospital, but only 4.8% due to gastric rete ntion. Conclusions: Gastrojejunoanastomosis is a good palliative procedure in patients with unresectable pancratic carcinoma. It should be performed i n every such patient who is subjected to a bilio digestive diversion and in whom a survival of some months can be predicted.