Palliative Treatment of Gastric Outlet Obstruction in Advanced Pancreatic Carcinoma

Abstract

There is controversy concerning the optimal surgical palliation for patients with pancreatic cancer. One issue debated is whether to add gastroenterostomy routinely in patients undergoing palliative biliary bypass for obstructive jaundice and, lately, also whether gastroenterostomy is helpful in any patients with pancreatic cancer. According to the literature, gastroenterostomy produces variable and often disappointing results in duodenal obstruction due to pancreatic carcinoma [1, 2]. Opponents and proponents abound on both sides. Data on the effectiveness of biliary decompression and the incidence of recurrent biliary obstruction in pancreatic cancer are easily found; in contrast, surprisingly little has been reported on the efficacy of gastrojejunostomy in alleviating nausea and vomiting or enabling the patient to eat once pancreatic carcinoma obstructs the gastric outlet. Despite this lack of data, some surgeons by tradition routinely add gastrojejunostomy as a palliative procedure, whatever the state of the duodenum or the size and situation of the tumor, when operating on a patient with pancreatic carcinoma. We have compiled the experience of gastroenterostomy in pancreatic cancer in our hospital, with special reference to the changing policy of using gastroenterostomy over time.