RANDOMIZED CLINICAL TRIAL OF TWO TYPES OF BYPASS OPERATIONS IN UNRESECTABLE PANCREAS HEAD CANCER
SEZAİ YILMAZ1, VEDAT KIRIMLIOĞLU2, CÜNEYT KAYAALP2, MEHMET ÇAĞLI KÜLEKÇİ2, KEMAL ARDA3, METİN ŞAVKILIOĞLU2, MUSA AKOĞLU2
1İnönü Üniversitesi Tıp Fakültesi, Genel Cerrahi ABD, MALATYA
2Türkiye Yüksek İhtisas Hastanesi, Gastroenteroloji Cerrahisi Kliniği, ANKARA
3Türkiye Yüksek İhtisas Hastanesi, Radyoloji Departmanı, ANKARA
A comparison of the palliative bypass procedures of the- non-resectable tumors of the head of the pancreas without duodenal obstruction. The addition of the prophylactic gastrointestinal bypass procedures to the therapeutic biliodigestive bypass procedures in non-resectable tumors of the head of the pancreas is strictly recommended to avoid an impending duodenal obstruction. Related to this subject, not too insisted and unsolved problem is location at each other of biliodigestive bypass and gastroenterostomy. A total of 27 patients with unresectable carcinoma of the head of the pancreas with either distant metastasis or in advanced stage without duodenal obstruction were treated in our institute during the period from May 1994 through May 1997. In this prospective randomized study, we performed a triple bypass in the first group in a fashion of antecolic gastrojejunostomy, jejunojejunostomy and a hepaticojejunostomy from cranial to the caudal after completing cholecystectomy. In the second group the patients underwent hepaticojejunostomy and gastrojejunostomy from cranial to the caudal so called double bypass after completing the cholecystectomy. There was not any statistically significant difference concerning the intraoperative mortality, reoperations, total mortality, delayed gastric emptying, hospital stay, late gastrointestinal bleeding and survival (p >0.05). But the delayed gastric emptying in the advanced tumor patients of the first group-so called triple bypass patients were less than the double bypass patients, which was appreative (% 15 % versus 30 % p >0.05). Time of the hospitalization and the commencement of the oral diet in the female patients were longer then the male patients (p <0.05). Although both types of the bypass procedures in the female patients with the unresectable tumors of the head of the pancreas with impending duodenal obstruction are acceptable, the triple bypass procedures performed in the first group of patients revealed better results than the double bypass procedures performed in the second group of patients.
Keywords: PANCREATIC CANCER, PANCREATIC HEAD CANCER, PROPHYLACTIC OPERATIONS