title: Outcome of palliative biliary and gastric bypass surgery for pancreatic head carcinoma in 126 patients.
abstract: BACKGROUND
  Recent reports of decreased morbidity and mortality following palliative surgery for patients with irresectable pancreatic head carcinoma prompted a review of the results in 126 patients (median age 64 (range 39-90) years) who had undergone palliative biliary and gastric bypass surgery.
  
  
  METHODS
  The indication for surgical palliation was the finding of an irresectable tumour at laparotomy (n = 44), failure of endoscopic treatment (n = 43), clinical symptoms of gastric outlet obstruction (n = 28) and miscellaneous (n = 11). Biliary and gastric bypass was performed in 118 patients, biliary bypass alone in six and gastrojejunostomy alone in two. The indication for gastrojejunostomy was symptoms in 28 patients (23 per cent) and prophylaxis in 92 patients (77 per cent).
  
  
  RESULTS
  Postoperative local complications occurred in 17 per cent of patients, general complications in 10 per cent and delayed gastric emptying in 14 per cent of patients. The 30-day mortality rate was 1 per cent and overall hospital mortality rate 2 per cent. Median hospital stay was 17 (range 5-80) days. Median overall postoperative survival was 190 (range 14-830) days. Late obstructive gastrointestinal symptoms occurred in 14 patients (11 per cent) after a median of 141 (range 21-356) days.
  
  
  CONCLUSIONS
  Roux-en-Y hepaticojejunostomy combined with gastrojejunostomy offers effective palliation for irresectable pancreatic head cancer and can be performed with low mortality and acceptable morbidity rates.
authors.affiliation: Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: B A
authors.initials: BA
authors.lastname: van Wagensveld
authors.forename: P P
authors.initials: PP
authors.lastname: Coene
authors.forename: T M
authors.initials: TM
authors.lastname: van Gulik
authors.forename: E A
authors.initials: EA
authors.lastname: Rauws
authors.forename: H
authors.initials: H
authors.lastname: Obertop
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015904:Biliopancreatic Diversion / Q000379:methods* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011182:Postoperative Care / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome