The Role of Prophylactic Gastrojejunostomy in Unresectable Periampullary Cancer

Kim, Chung Yun; Lee, Won Jin; Boo, Yun Jung; Kim, Jin; Lee, Gyeong Chul; Song, Tae Jin; Cho, Min Young; Suh, Sung Ock; Whang, Cheong Wung; Kim, Young Chul

Abstract

PURPOSE
It was reported that 25% to 75% patients with a periampullary cancer were found to be unresectable after exploratory surgery. The aim of this study was to evaluate the role of a prophylactic gastrojejunostomy in patients with an unresectable periampullary cancer. METHODS: During January 1999 to April 2004, a prophylactic gastrojejunostomy (GJ group) or no gastrojejunostomy (non-GJ group) was carried out for an unresectable periampullary cancer without a gastric outlet obstruction in 42 patients. The clinicopathological characteristics, postoperative complications and time survival were evaluated retrospectively. RESULTS: Of the 42 patients, a prophylactic gastrojejunostomy was performed in 24 cases. There were no immediate postoperative deaths in both groups, and the postoperative morbidity rate was similar in both groups (GJ group 10% vs non-GJ group 7%). There were no differences in the mean postoperative hospital stay (GJ group 29.5 days vs non-GJ group 26.8 days) and mean survival (GJ group 7.5 months vs non-GJ group 8.1 months) between the two groups. In the 5 of the non-GJ group (27%), a postoperative gastric outlet obstruction had developed. The median interval time between the initial exploration and the postoperative gastrojejunostomy was 4.1 months. CONCLUSION: Although a small number of patients developed a postoperative gastric outlet obstruction in the non-GJ group, the prophylactic gastrojejunostomy did not increase the number of postoperative complications or the length of hospitalstay. However, several patients who did not received the prophylactic gastrojejunostomy developed a duodenal obstruction. Furthermore they needed a prophylactic gastrojejunostomy. These results suggest that a prophylactic gastrojejunostomy is a necessary and feasible procedure for patients with an unresectable periampullary cancer without duodenal obstructive symptoms.