Carcinoma of the head of the pancreas: Bypass surgery in unresectable disease

One hundred patients who underwent bypass surgery for unresectable, histologically proven carcinoma of the head of the pancreas were studied to determine: (1) the incidence of a second operation for duodenal obstruction in survivors who had a biliary diversion only; (2) whether the addition of a prophylactic gastroenterostomy is associated with increased mortality. Eighty-six patients (Group A) had a biliary diversion alone while fourteen (Group B) had a biliary diversion and a prophylactic gastroenterostomy. Both groups were comparable regarding sex, age, symptomatology and clinical findings. The postoperative mortality was similar for both groups (Group A, 27·9 per cent; Group B, 14·3 per cent). The mean surgically related hospital stay was 22·6·5 days (Group A) and 20·7 days (Group B). Of the 62 patients in Group A who left hospital, 8 (13 per cent) required a second operation for duodenal obstruction (mean interval 5·4 ± 2·7 months). The in-hospital stay for the second operation was 14·4·7·7 days. The overall survival for both groups was identical at 6 months (35·5 versus 33·3 per cent) and 12 months (19·3 versus 16·7 per cent). This study suggests that prophylactic gastroenterostomy adds no risk to patients requiring biliary diversion for carcinoma of the head of the pancreas. Its routine use is therefore justified since 13 per cent of the patients who survived the biliary diversion required further surgery for duodenal obstruction before death.