The outcome of laparoscopic gastrojejunostomy in malignant gastric outlet obstruction.

BACKGROUND AND AIMS: The development of gastric outlet obstruction (GOO) in patients with advanced pancreatic cancer is regarded by some as a terminal event. There are several interventional options available, one of which is laparoscopic gastrojejunostomy (LGJ). To date, there are little data on the effectiveness of this intervention. Using patient records we sought to analyze our own experience of LGJ in patients with terminal pancreatic cancer.

METHODS: A retrospective analysis of all patients with pancreatic or peri-ampullary cancer that underwent LGJ for GOO. All LGJ were performed by two consultant surgeons at Glasgow Royal Infirmary. Patient notes were assessed for survival time after LGJ; post-operative complications; resumption of oral intake; time to discharge and recurrence of GOO after surgery.

RESULTS: A total of 18 patients underwent LGJ for GOO between 2000 and 2004. Median age at time of procedure was 66.5 yr (range 40 to 79). Two patients were converted to an open procedure for technical reasons, both of whom died in the post-operative period. Of the remaining 16, 15 had successful relief of GOO. The remaining patient underwent revisional open surgery 15 d post-operatively due to persistent GOO. Two patients died in hospital but 14 were discharged with symptom relief. Median survival for these patients was 59 d (range 12 to 248).

CONCLUSION: The development of GOO in pancreatic and peri-ampullary cancer should not be regarded as a terminal event. LGJ should be considered as a treatment option in these patients.