Partial separating gastrojejunostomy for incurable cancer of the stomach or pancreas.

BACKGROUND/AIMS: Advanced stomach or pancreas cancer with antral obstruction has been treated by gastrojejunostomy. The delayed return of gastric emptying, however, frequently occurs. The Devine exclusion procedure has been reported to be the better bypass operation in terms of oral intake, but it needs a drainage tube. In cases where the lesser curvature is invaded, this operation should be avoided. A method of gastroenterostomy, which is safe and shows good outcomes concerning oral intake, is desired.

METHODOLOGY: Among 15 patients with advanced stomach or pancreas cancer, 8 received conventional gastrojejunostomy (CG Group), 3 Devine exclusive gastrectomy with a drainage tube (DE Group) and 4 partial separating gastrojejunostomy (PG Group). The partial separating gastrojejunostomy was performed as follows. The stomach was partially partitioned using GIA from the side of the greater curvature. The posterior side of the proximal stomach was anastomosed with the proximal jejunum using a circular stapler instrument.

RESULTS

All patients in the DE and SG Groups could eat regular or semi-regular meals. The bleeding from tumor in the DE Group was less than that in the SG and CG Groups.

CONCLUSIONS

In cases where the lesser curvature is invaded by tumor or lymph node metastasis, partial separating gastrojejunostomy would be recommended as a substitute for the Devine procedure.