Role of Palliative Gastrojejunostomy for Unresectable Periampullary Carcinoma

ABSTRACT

PURPOSE: Most patients diagnosed with a periampullary carcinoma are defined as having an unresectable tumor. Therefore, the appropriate relief of the main symptoms such as obstructive jaundice, duodenal obstruction, and pain is of utmost importance to these patients. In these patients, a biliary bypass can improve the quality of life. However, there is some controversy regarding the efficacy of gastrojejunostomy for preventing a duodenal obstruction. This study, evaluated the effect of a palliative gastrojejunostomy and the quality of life in patients with an unresectable periampullary carcinoma. METHODS: Between January 2000 and December 2003, among a total of 46 patients with an unresectable periampullary carcinoma, 24 patients underwent a palliative gastrojejunostomy (Group I) and 22 patients underwent non surgical management (Group II). In these two groups the frequency of nausea and vomiting, serum protein and albumin levels, oral intake, and other metrics were carefully monitored. RESULTS: Of the 46 patients, there were no significant differences in terms of age, gender, TNM stage, and preoperative symptoms. The incidence of nausea and vomiting preoperatively were similar in both groups (43.8% and 40.5%, respectively, P=0.126). However, there were statistically significant differences at the three months after surgery (36.6%, 54.5%, P=0.033). The preoperative protein and albumin were similar in both groups (6.6 g/dl, 6.4 g/dl). On the other hand, protein and albumin levels 3 months after surgery were significantly different (5.9 g/dl, 5.2 g/dl, P=0.010). CONCLUSION: These results suggest a palliative gastrojejunostomy in patients with an unresectable periampullary cancer can reduce the symptoms related to a duodenal obstruction and might contribute to maintaining the patients' quality of life secondary to possible oral intake for a longer period postoperatively.