title: Palliative enteric bypass for malignant gastric outflow obstruction after pancreaticoduodenectomy in early recurrent pancreatic cancer.
abstract: OBJECTIVE
  Recurrent pancreatic cancer has a poor prognosis and there are no established therapeutic strategies. We retrospectively studied patients who underwent palliative surgery for recurrent disease with gastric outlet obstruction (GOO) after an initial pancreaticoduodenectomy (PD) for pancreatic cancer.
  
  
  METHODS
  We retrospectively studied 4 patients who had undergone a bypass operation, including a modified Devine gastrojejunostomy with vertical stomach reconstruction (MDVSR) for GOO to ensure a direct dietary route to the jejunum, thereby, enabling the gastric contents to easily reach the jejunum.
  
  
  RESULTS
  MDVSR was performed in 4 patients, and in addition to the bypass, 1 patient underwent a jejunojejunostomy, and 1 patient an ileocolostomy. The median operative time and blood loss were 123min (range, 95-150 min) and 164mL (range, 115-235 mL). After the second surgery, 2 of 4 patients received chemotherapy (1 patient: gemcitabine + S1, 1 patient: gemcitabine alone). The remaining 2 patients did not receive chemotherapy. The mean survival after the second operation was 145 days (range, 34-386 days).
  
  
  CONCLUSIONS
  Palliative surgery including MDVSR is useful to improve a patient's nutritional state and it is more effective than chemotherapy for treating recurrent disease with GOO after a PD for pancreatic cancer.
authors.affiliation: Department of Surgery, Social Insurance Yokohama Central Hospital, Yokohama, Japan. ooida.takatsugu@yokochu.jp
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Oida
authors.forename: Kenji
authors.initials: K
authors.lastname: Mimatsu
authors.forename: Hisao
authors.initials: H
authors.lastname: Kano
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawasaki
authors.forename: Youichi
authors.initials: Y
authors.lastname: Kuboi
authors.forename: Nobutada
authors.initials: N
authors.lastname: Fukino
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Kida
authors.forename: Osamu
authors.initials: O
authors.lastname: Aramaki
authors.forename: Sadao
authors.initials: S
authors.lastname: Amano
mesh_terms: D000368:Aged; D005260:Female; D017219:Gastric Outlet Obstruction / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*