Yoshihiro Miyasaka, Yasuhisa Mori, Kohei Nakata, Takao Ohtsuka, Masafumi Nakamura
Objective Pancreatic head cancer is frequently associated with biliary obstruction and gastric outlet obstruction. We have performed biliary and gastrointestinal bypass, even for patients with unresectable pancreatic head cancer without either biliary obstruction or gastric outlet obstruction, to prevent biliary obstruction and gastric outlet obstruction and thus ensure planned chemotherapy as well as to maintain the patients’ quality of life. We therefore evaluated the safety and preventive effect of prophylactic biliary and gastrointestinal bypass. Methods We retrospectively reviewed the data of patients with unresectable pancreatic head cancer from 2001 to 2013. We then selected the patients without either biliary obstruction or gastric outlet obstruction and divided them into a prophylactic biliary and gastrointestinal bypass group and a control group. The perioperative outcomes of prophylactic biliary and gastrointestinal bypass were analyzed, and long-term outcomes including the incidence of biliary obstruction and gastric outlet obstruction were compared between the prophylactic biliary and gastrointestinal bypass group and the control group. Results Of 151 patients with unresectable pancreatic head cancer, 58 had neither biliary obstruction nor gastric outlet obstruction. Of these 58 patients, 32 underwent prophylactic biliary and gastrointestinal bypass. The median operation time, blood loss, and postoperative hospital stay were 272 minutes, 173 ml, and 18 days. Only one patient had postoperative morbidity after prophylactic biliary and gastrointestinal bypass. No patients in the prophylactic biliary and gastrointestinal bypass group developed either biliary obstruction or gastric outlet obstruction, while 81% developed biliary obstruction and 42% developed gastric outlet obstruction in the control group. Overall survival was comparable between the two groups. Conclusion Prophylactic biliary and gastrointestinal bypass showed excellent preventive effects on biliary obstruction and gastric outlet obstruction with low morbidity. Although nonsurgical palliative procedures are preferred for the treatment of biliary obstruction and gastric outlet obstruction, it is time to reappraise prophylactic surgical procedures for unresectable pancreatic head cancer.
