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KMID : 0870420040080040249
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2004 Volume.8 No. 4 p.249 ~ p.253
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The Role of Prophylactic Gastrojejunostomy in Unresectable Periampullary Cancer
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Kim Chung-Yun
Seo Seong-Ok
Whang Jeong-Woong
Kim Young-Chul
Lee Won-Jin
Boo Yoon-Jeong
Kim Jin
Lee Gyeong-Chul
Song Tae-Jin
Cho Min-Young
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Abstract
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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 hospital stay. 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.
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KEYWORD
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Carcinoma, Ampulla, Pancreas, Bile Duct, Gastrojejunostomy
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