Surgery to Connect the Stomach with the Jejunum May Prevent Pancreatic Cancer

Initial Surgery to Connect the Stomach with the Jejunum May Prevent Obstruction of the Stomach with Pancreatic Cancer

Initial Surgery to Connect the Stomach with the Jejunum May Prevent Obstruction of the Stomach in Persons with Inoperable Pancreatic Cancer

For persons with inoperable cancer of the head of the pancreas, a procedure called a gastrojejunostomy, performed during initial exploratory surgery, may help prevent any blockage of the stomach that could occur. This means that persons who undergo this procedure prophylactically may have a better chance to continue eating and drinking relatively normally, avoiding the obstruction of the stomach that might have otherwise occurred.

The

pancreas is an organ that is surrounded by the stomach, small intestine, bile ducts (tubes that connect the liver to the small intestine), gallbladder, liver, and spleen. The pancreas is wider on its right side (called the

head) and is narrowest on its left side (called the

tail). The pancreas helps the body to break down food and produces hormones, such as insulin, to regulate the body’s storage and use of food. Depending on the

stage of disease (extent of cancer at the time of diagnosis), pancreatic cancer may be treated with surgery, radiation therapy, chemotherapy, and/or biologic therapy to fight the cancer, relieve some of the symptoms of cancer, and/or prolong survival time.

Some persons who have pancreatic cancer undergo

exploratory surgery, to determine where the cancer is located in the pancreas and whether it has spread to other areas. During the surgery, doctors can sometimes remove part or all of the pancreas and upper section of the small intestine, called the

duodenum, if needed, to remove the cancer. However, for many persons who undergo such exploratory surgery, the cancer has spread and cannot be surgically removed. When cancer of the head of the pancreas begins to grow in the area of the bile ducts, it can block the bile ducts and the stomach from emptying into the duodenum. For individuals with this type of cancer, a surgery called a

gastrojejunostomy may be performed to connect the bile ducts as well as the stomach to the second section of the small intestine, the

jejunum. This procedure allows the stomach to bypass the duodenum and empty directly into the jejunum, hopefully enabling persons with this disease to continue to eat and drink relatively normally. The question under study is: Is this procedure of more benefit when it is performed immediately during the exploratory surgery (before obstruction of the stomach and/or bile ducts occurs) or later after the obstruction occurs?

Researchers at the Johns Hopkins Medical Institution in Baltimore performed exploratory surgery in 194 persons with inoperable cancer of the pancreas. One hundred seven of these had an immediate gastrojejunostomy because of impending obstruction of the stomach. The remaining 87 patients, who were not in immediate danger of such obstruction, were assigned to receive either A) a prophylactic gastrojejunostomy or B) no further immediate surgery. The results yielded no post-operative complications and no deaths from surgery; the length of the hospital stay was similar between the 2 groups. The average survival time was 8.3 months in both groups. In persons who had the immediate gastrojejunostomy, none went on to develop obstruction of the stomach. However, in the group that did not have the procedure, 8 patients (19%) developed late obstruction of the stomach. Seven of these persons then underwent a gastrojejunostomy, which was performed an average of 2 months after the initial exploratory surgery.

The researchers concluded that a gastrojejunostomy, performed during the initial exploratory surgery, significantly decreased the incidence of obstruction of the stomach in persons with inoperable cancer of the head of the pancreas. Since the procedure appears not to increase the surgical complications over those of exploratory surgery alone, the researchers advised that all persons with this type of disease receive a prophylactic gastrojejunostomy. Individuals who have inoperable pancreatic cancer may wish to talk with their doctor about the risks and benefits of undergoing a prophylactic gastrojejunostomy and of participating in a clinical trial in which promising new treatment approaches are being studied. (

Annals of Surgery, Vol 230, No 3, pp 322-328, 1999)

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