Duodenal Obstruction Develops Frequently in Unresectable Pancreatic Cancer with Modern Medical Management

Abstract

Purpose: To determine the rate of development of gastric outlet obstruction requiring intervention in patients with unresectable pancreatic adenocarcinoma. Methods: This was a retrospective chart review study carried out at a single center tertiary referral center. All patients who were diagnosed with unresectable pancreatic adenocarcinoma (locally invasive, vascular involvement or metastatic disease) were retrospectively reviewed from January, 2001 through December, 2012. Patients with unresectable cancer were identified through an electronic medical record by the placement of a metal biliary stent. Patient charts were then reviewed to see who developed duodenal obstruction and later received duodenal stent placement. Baseline demographic information, date of diagnosis, date of surgery or stent placement, if the patient was receiving chemotherapy and/or radiation therapy, and the date of death (if applicable) were collected. Patients were also excluded if they had a duodenal stent placed at a different institution, or for GOO from another malignancy, such as cholangiocarcinoma, pancreatic neuroendocrine tumor, lymphoma, gastric adenocarcinoma and metastatic colon cancer. Results: A total of 105 patients with unresectable pancreatic adenocarcinoma were identified from 2001-2012. Of the 105 patients, 32 patients were lost to follow-up, meaning after diagnosis, they either followed up at outside institutions or did not follow up at all for further medical care. A total of 28 patients developed signs and symptoms of gastric outlet obstruction. Twenty-seven of them underwent endoscopic duodenal stent placement, and one of them underwent a diverting gastro-jejunostomy. The overall rate of developing outlet obstruction was calculated to be 38%. The average length of time from diagnosis of pancreatic adenocarcinoma to development of duodenal outlet obstruction was calculated to be 11 months. Average length of time from the development of outlet obstruction to death was calculated to be 4 months. Of the patients who developed GOO, a total of 34 patients (47%) received chemotherapy, with 31 patients (43%) receiving combination chemoradiation. Conclusion: The risk of developing gastric outlet obstruction from pancreatic adenocarcinoma is 38%, which is much higher than studies reported prior to routine use of chemoradiation. The average length of time from developing outlet obstruction to death is four months.