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August 1994

Antrectomy: A Safe and Effective Bypass for Unresectable Pancreatic Cancer

Author Affiliations

From the Department of Surgery, Wayne State University, Detroit, Mich (Drs Lucas, Ledgerwood, and Saxe, and Mr Lucas), and the Department of Surgery, Francis Scott Key Medical Center, Baltimore, Md (Dr Bender).

Arch Surg. 1994;129(8):795-799. doi:10.1001/archsurg.1994.01420320017001

Background:  Pancreatic cancer is most often diagnosed too late for curative resection. Operative therapy, therefore, involves relief of biliary obstruction and relief or prevention of gastric outlet obstruction. Previous studies show that gastrojejunostomy done either therapeutically or prophylactically often causes delayed gastric emptying.

Objective:  To describe the results of antrectomy with Billroth II reconstruction (A/BII) as the palliative operation for gastric outlet obstruction.

Subjects:  Fifty patients with unresectable pancreatic cancer underwent A/BII without vagotomy from 1987 through 1993. Of these patients, 42 underwent simultaneous biliary bypass; six had undergone biliary bypass from 3 weeks to 34 months previously; and two with cancer originating in the uncinate process had no biliary bypass.

Results:  One 87-year-old patient died on day 12 of azotemia and pulmonary insufficiency. The other 49 patients were discharged tolerating an oral diet an average of 11.3 days (range, 5 to 29 days) after A/BII. The length of stay following A/BII was not related to the extent of disease or to preoperative weight loss but was increased in older patients.

Conclusion:  The A/BII is a safe and effective bypass in patients with unresectable pancreatic cancer.(Arch Surg. 1994;129:795-799)

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