Brief Article
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World J Gastroenterol. Dec 7, 2013; 19(45): 8321-8325
Published online Dec 7, 2013. doi: 10.3748/wjg.v19.i45.8321
Gastrojejunostomy in patients with unresectable pancreatic head cancer - the use of Roux loop significantly shortens the hospital length of stay
Dariusz Szymanski, Adam Durczynski, Michal Nowicki, Janusz Strzelczyk
Dariusz Szymanski, Adam Durczynski, Michal Nowicki, Janusz Strzelczyk, Department of General and Transplant Surgery, Barlicki University Hospital, Medical University of Lodz, 0-153 Lodz, Poland
Author contributions: All authors contributed equally to this work.
Correspondence to: Adam Durczynski MD, PhD, Department of General and Transplant Surgery, Medical University of Lodz, Barlicki University Hospital, Kopcinskiego Street 22, 90-153 Lodz, Poland. a.durczynski@interia.pl
Telephone: +48-42-6776755 Fax: +48-42-6791091
Received: May 7, 2013
Revised: August 12, 2013
Accepted: September 15, 2013
Published online: December 7, 2013
Abstract

AIM: To evaluate the use of the Roux loop on the postoperative course in patients submitted for gastroenteroanastomosis (GE).

METHODS: Non-jaundiced patients (n = 41) operated on in the Department of General and Transplant Surgery in Lodz, between January 2010 and December 2011 were enrolled. The tumor was considered unresectable when liver metastases or major vascular involvement were confirmed. Patients were randomized to receive Roux (n = 21) or conventional GE (n = 20) on a prophylactic basis.

RESULTS: The mean time to nasogastric tube withdrawal in Roux GE group was shorter (1.4 ± 0.75 vs 2.8 ± 1.1, P < 0.001). Time to starting oral liquids, soft diet and regular diet were decreased (2.3 ± 0.86 vs 3.45 ± 1.19; P < 0.001; 3.3 ± 0.73 vs 4.4 ± 1.23, P < 0.001 and 4.5 ± 0.76 vs 5.6 ± 1.42, P = 0.002; respectively). The Roux GE group had a lower use of prokinetics (10 mg thrice daily for 2.2 ± 1.8 d vs 3.7 ± 2.6 d, P = 0.044; total 62 ± 49 mg vs 111 ± 79 mg, P = 0.025). The mean hospitalization time following Roux GE was shorter (7.7 d vs 9.6 d, P = 0.006). Delayed gastric emptying (DGE) was confirmed in 20% after conventional GE but in none of the patients following Roux GE.

CONCLUSION: Roux gastrojejunostomy during open abdomen exploration in patients with unresectable pancreatic cancer is easy to perform, decreases the incidence of DGE and lowers hospitalization time.

Keywords: Unresectable pancreatic cancer, Roux and conventional gastroeneteroanastomosis, Gastroenteroanastomosis, Delayed gastric emptying, Hospital length of stay

Core tip: The lower rate of delayed gastric emptying, which determines lower use of prokinetics after Roux compared to conventional antegastric gastroenterostomy (GE) suggested that prophylactic Roux GE should be performed during surgical exploration of patients with unresectable pancreatic head tumors. The length of hospital stay is shorter following palliative Roux GE, thus the treatment costs of these patients are likely to be smaller. Further research is needed on the cost-effectiveness of prophylactic Roux GE in unresectable pancreatic cancer.