B. A. Potz1, C. C. Ciambella1, V. L. Garcia1, K. P. Charpentier1, W. G. Cioffi1, T. J. Miner1 1Rhode Island Hospital,Surgical Oncology,Providence, RI, USA
Introduction: A gastrojejunostomy (GJ) is commonly created to manage a broad range of general surgical problems. Understanding the differences in groups of patients undergoing this procedure may allow improved patient selection and perioperative management.
Methods: 10 year retrospective review of a prospective surgical database. 386 consecutive adult patients were evaluated for operative indications, gastric outlet obstruction (GOO) scores, technical details, perioperative management, surgical outcomes, NGT tube utilization. Surgical intent to identify palliative operations was determined by previously established criteria.
Results: 295(76%) of the 386 GJ were performed as part of a cancer operation. 301 (77%) of the GJ were associated with partial gastrectomy (PG) included with the surgical procedure. Antecolic reconstruction was performed in 282 (73%). Cancer operations were associated with severe (GOO=0, 46%, p<0.001) and moderate preoperative symptoms (GOO1-3, 26%, p<0.001). GJ with concurrent PG (235/386, 61%) was more frequently performed in asymptomatic patients (205/287 (87%), p<0.001). Palliative intent was documented in 22% (64/295) and associated with cancer operation without PG (60/60 100%, p<0.001). Following operation, documented symptom improvement was noted in 85% (84/99) of patients who initially presented with obstructive symptoms. There was no difference in length of stay (mean 7 days) or major complication rates (14%) between groups(specify which “groups” here). 30-day mortality was associated with operations performed with palliative intent (11/64 (17%), p<0.001). GJ without PG was associated with postoperative NGT placement more frequently than operations with PG (81/85 (95%), p<0.001). GJ without PG were also associate with longer duration of tube placement (mean 1 vs 5 days, p<0.001) and more frequent NGT issues requiring replacement (16/85 (19%), p=0.004). There was no significant difference in rates of delayed gastric emptying (51/386 (13%)) between groups.
Conclusion: There are distinct differences amongst groups of patients undergoing an operation which includes GJ. Active symptom management is more frequently required for cancer patients. 30-day mortality is associated with palliative operations. Regardless of indication, prolonged NGT management is associated with GJ without PG probably due to worse gastric drainage. Appreciation of such factors not only improves patient selection and counseling, but also will allow more precise analysis of administrative data in the future.