Partial Stomach-Partitioning Gastrojejunostomy (PSPG) for Malignant Gastric Outlet Obstruction
Abstracts
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Objective: Stomach-partitioning gastrojejunostomy has been described for unresectable gastric cancer (Arch Surg. 1997;132:184). The study purpose was to compare the results of partial stomach-partitioning gastrojejunostomy (PSPG) for malignant gastric outlet and duodenal obstruction to those of antrectomy and gastrojejunostomy. Methods: A retrospective review of 26 patients with unresectable malignant gastric outlet and duodenal obstruction was performed. Length of hospital stay, ability to eat solid food, and post-operative morbidity were assessed. Results: Nine patients underwent antrectomy with gastrojejunostomy and 17 patients underwent PSPG. Patients were comparable with respect to age, tumor stage, and presenting symptoms. All patients in the antrectomy and gastrojejunostomy group had pancreatic adenocarcinoma. More varied pathology was seen in the PSPG group with cause of obstruction being pancreatic adenocarcinoma (8), colon cancer (4), gallbladder cancer (2), gastric cancer (1), ampullary cancer (1), and pancreatic islet cell tumor (1). Four of 9 patients in the antrectomy and gastrojejunostomy group and 9 of 18 patients in the PSPG group underwent simultaneous biliary bypass. The average length of stay in the antrectomy and gastrojejunostomy group was 14.6 days (range 7-35) compared to 9.6 days (range 4-25) in the PSPG group. Sixty percent in the antrectomy group and 100% in the PSPG group were tolerating solids upon discharge. Significant post-operative complications occurred in 44% of the antrectomy group and 16% of the PSPG group. One patient in the antrectomy and gastrojejunostomy group was lost to follow-up. Average follow-up in the remaining 8 patients was 6.4 months. All patients in this group have since expired with 3 unable to tolerate solids at death and 1 patient taking limited liquid intake. Three patients in the PSPG group were lost to follow-up. The remaining 14 patients had an average follow-up of 7.8 months. Of the 6 patients who have since expired, 4 were tolerating solids, and 1 was tolerating full liquids until death. The remaining 8 patients were all still tolerating solid intake at last follow-up. Conclusion: PSPG is an alternative method of providing palliative bypass for patients with unresectable malignant gastric outlet and duodenal obstruction. Outcomes are superior to those achieved with antrectomy and gastrojejunostomy. Patients have a shorter hospital stay, less morbidity, and are better able to tolerate solid food postoperatively. |
