Surgical palliation in pancreatic head carcinoma and gastric cancer: the role of laparoscopy.
OBJECTIVE
In all patients with pancreatic and gastric cancer we always make a laparoscopic exploration to complete the staging. Lately we have adopted the following technique for nonresectable cancers of the head of the pancreas: following endoscopic retrograde cholangiography we position a biliary stent to restore bile flow and obtain regression of jaundice, a laparoscopic-assisted gastroentero-anastomosis (GEA) is then performed as an antecolic isoperistaltic side-to-side gastrojejunostomy. Also in case of nonresectable gastric cancer we perform a laparoscopic-assisted gastrojejunostomy.


METHODS
From January 1994-February 1998 we performed a total of 25 laparoscopic assisted gastrojejunostomies. We adopted this minimally invasive technique for 11 out of 20 patients (55%) with nonresectable cancers of the head of the pancreas, 7 men and 4 women, whose median age was 73 (range: 60-89). A video-assisted gastrojejunostomy was also performed in 14 patients out of 28 (50%), 10 men and 3 women, with a median age of 70 (range: 58-76), with nonresectable distal gastric cancers and 1 woman with non-resectable and obstructing duodenal cancer. The operative time of the video-assisted procedure was 35 min (range: 25-40 min).


RESULTS
There were no intra-operative complications and no mortality. All the patients had a very satisfactory post-operative course, with only 1 (4%) with post-operative complications (hyperpyrexia in a patient due to an infection of the biliaryendoprosthesis, with precocious regression after replacement of the prosthesis) and minimal post-operative pain. Median post-operative hospital stay was 3 days (range: 2-4). Median survival after operation was 6 months (range: 2-12) for gastric cancer and 9 months (range: 5-15 months) for pancreatic head carcinoma.


CONCLUSIONS
We believe that this technique, for the obstructive syndrome of the pylorus and duodenum, offers these patients the best results/trauma ratio. Two currently remaining types of indications for a GEA, namely non-malignant ulcer and unresectable duodenal or antropyloric obstructive cancer.
Croce
E
E
1st Department of General and Thoracic Surgery, Fatebenefratelli and Oftalmico Hospital, Milano, Italy.
Olmi
S
S
Azzola
M
M
Russo
R
R
Golia
M
M
D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002779:Cholestasis / Q000209:etiology / Q000628:therapy; D005260:Female; D005763:Gastroenterostomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015607:Stents; D013274:Stomach Neoplasms / Q000601:surgery*