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© Borgis - New Medicine 2/2015, s. 62-65 | DOI: 10.5604/14270994.1169798
*Konrad Wroński1, 2, Przemysław Stefaniak2
New type of prophylactic gastroenterostomy in patient with unresectable pancreatic head carcinoma
1Department of Oncology, Faculty of Medicine, University of Warmia and Mazury, Olsztyn, Poland
Head of Department: prof. Sergiusz Nawrocki, MD, PhD
2Department of Surgical Oncology, Hospital Ministry of Internal Affairs with Warmia and Mazury Oncology Centre, Olsztyn, Poland
Head of Department: Andrzej Lachowski, MD
Summary
Pancreatic cancer is a important public health problem all over the world. Up to 80% patients with carcinoma of head of the pancreas are unresectable because of local vascular invasion or distant metastasis. Optimal treatment of such patients is surgical bypass. The number of patients with unresectable pancreatic head cancers is increasing and their optimal treatment is a big economic problem for health care. Traditional prophylactic gastroenterostomy has many complications in postoperative period. Because of complications period of stay in hospital extended and generates additional costs. In this article the authors presented a case of a Caucasian woman who was admitted to the hospital because of unresectable pancreatic head cancer. The patient underwent new type of prophylactic gastroenterostomy and in the sixth day after surgery was discharged home. The authors invented this new type of anastomosis and applied it successfully in several patients with unresectable carcinoma of head of the pancreas.
INTRODUCTION
Pancreatic cancer is a important public health problem all over the world. Up to 80% patients with carcinoma of head of the pancreas are unresectable because of local vascular invasion or distant metastasis (1). Optimal treatment of such patients is surgical bypass. The number of patients with unresectable pancreatic head cancers is increasing and their optimal treatment is a big economic problem for health care. Traditional prophylactic gastroenterostomy has many complications in postoperative period. Because of complications period of stay in hospital extended and generates additional costs. In this article the authors presented a case of a Caucasian woman who was admitted to the hospital because of unresectable pancreatic head cancer. The patient underwent new type of prophylactic gastroenterostomy and in the sixth day after surgery was discharged home. The authors invented this new type of anastomosis and applied it successfully in several patients with unresectable carcinoma of head of the pancreas.
CASE REPORT
A 71-year-old woman, Caucasian race, with pancreatic head tumor, was admitted to the Department of Surgical Oncology because of obstructive symptoms of upper gastrointestinal tract. The patient did not eat the food for last 2 weeks, drank only water. Within a month, she lost about 20 kg. She was treated chronically with hypertension and ischemic heart disease.
Blood examination of the patient showed low levels of hemoglobin, erythrocytes, albumin and total protein. Other laboratory tests were normal.
On physical examination, in the epigastrium area there was palpable a tumor. CT examination showed a pathological mesogastric lumpy mass in the region of the descending duodenum and the head of the pancreas, which the size was approximately 75 x 68 x 45 mm. The rest of the pancreas was not enlarged. On CT scan a tumor of the pancreas head infiltrated and compressed the duodenum causing obstruction of the upper gastrointestinal tract.

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Piśmiennictwo
1. Watanapa P, Williamson RC: Surgical palliation for pancreatic cancer: developments during the past two decades. Br J Surg 1992; 79: 8-20. 2. Krzakowski M, Warzocha K (red.): Zalecenia postępowania diagnostyczno-terapeutycznego w nowotworach złośliwych 2013 rok. Via Medica, Gdańsk 2013. 3. Hwang SI, Kim HO, Son BH et al.: Surgical palliation of unresectable pancreatic head cancer in elderly patients. World J Gastroenterol 2009; 15: 978-982. 4. Huser N, Michalski CW, Schuster T et al.: Systematic review and meta-analysis of prophylactic gastroenterostomy for unresectable advanced pancreatic cancer. Br J Surg 2009; 96: 711-719. 5. Jacobs PP, van der Sluis RF, Wobbes T: Role of gastroenterostomy in the palliative surgical treatment of pancreatic cancer. J Surg Oncol 1989; 42: 145-149. 6. Weaver DW, Wiencek RG, Bouwman DL et al.: Gastrojejunostomy: is it helpful for patients with pancreatic cancer? Surgery 1987; 102: 608-613. 7. Doberneck RC, Berndt GA: Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arcg Surg 1987; 122: 827-829. 8. Smith AC, Dowsett JF, Russell RC et al.: Randomised trial of endoscopic stenting versus surgical bypass in malignant low bileduct obstruction. Lancet 1994; 344: 1655-1660. 9. Doberneck RC, Berndt GA: Delayed gastric emptying after palliative gastrojejunostomy for carcinoma of the pancreas. Arch Surg 1987; 122: 827-829. 10. Lesurtel M, Dehni N, Tiret E et al.: Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal. J Gastrointest Surg 2006; 10(2): 286-291. 11. Horstmann O, Kley CW, Post S, Becker H: Cross-section gastroenterostomy in patients with irresectable periampullary carcinoma. HPB (Oxford) 2001; 3: 157-163.
otrzymano: 2015-04-03
zaakceptowano do druku: 2015-05-21

Adres do korespondencji:
*Konrad Wroński
Department of Surgical Oncology Faculty of Medicine University of Warmia and Mazury in Olsztyn
37 al. Wojska Polskiego St., 10-228 Olsztyn, Poland
tel.: +48 505-818-126
e-mail: konradwronski@wp.pl

New Medicine 2/2015
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