Significance of palliative gastrojejunostomy for unresectable pancreatic head carcinoma

BACKGROUND/AIMS: When diagnosed, most patients with pancreatic head cancer are defined as having an unresectable tumor, and thus appropriate relief of main symptoms, such as, obstructive jaundice, duodenal obstruction, and pain, is the major concern. However, debate continues concerning the efficacy of gastrojejunostomy at preventing duodenal obstruction. In this study, we evaluated the effects of palliative gastrojejunostomy on the quality of life of patients with unresectable pancreatic head cancer.

METHODOLOGY: Between January 2000 and December 2004, of 61 patients with unresectable pancreatic head cancer, 46 underwent palliative surgery; 24 patients underwent biliary bypass with gastrojejunostomy (Group I) and 22 patients underwent biliary bypass only (Group II). Frequencies of nausea and vomiting, serum protein and albumin levels, oral intake, and other metrics were carefully monitored.

RESULTS: No significant differences in age, sex, TNM stage, and preoperative symptoms were evident between the two groups. Incidences of nausea and vomiting were similar preoperatively (Group I, 45.8%; Group II, 40.9%, P=0.736), but were significantly different at 3 months postoperatively (Group I, 25.0%; Group II, 68.2%, P=0.003). Preoperative serum protein and albumin levels were similar in the two groups (Group I: 6.6g/dL, 3.5g/dL; Group II: 6.4g/dL, 3.4g/dL, respectively, P-0.223, 0.472), but at 3 months postoperatively, serum protein and albumin levels were significantly different (Group I: 5.9g/dL, 3.1g/dL; Group II: 5.2g/dL, 2.6g/dL, respectively, P=0.010, 0.047).

CONCLUSIONS: Our data suggest that palliative gastrojejunostomy in patients with unresectable pancreatic head cancer reduces symptoms related to duodenal obstruction and contributes to quality of life.