Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2018; 24(18): 1978-1988
Published online May 14, 2018. doi: 10.3748/wjg.v24.i18.1978
Laparoscopic gastrojejunostomy for gastric outlet obstruction in patients with unresectable hepatopancreatobiliary cancers: A personal series and systematic review of the literature
Alba Manuel-Vázquez, Raquel Latorre-Fragua, Carmen Ramiro-Pérez, Aylhin López-Marcano, Roberto De la Plaza-Llamas, José Manuel Ramia
Alba Manuel-Vázquez, Raquel Latorre-Fragua, Carmen Ramiro-Pérez, Aylhin López-Marcano, Roberto De la Plaza-Llamas, José Manuel Ramia, Department of General and Digestive Surgery, University Hospital of Guadalajara, Guadalajara 19002, Spain
Author contributions: Manuel-Vázquez A designed the study, performed the research, analyzed data, and wrote the paper; Latorre-Fragua R, Ramiro-Pérez C, López-Marcano A performed the research, analyzed and interpreted of data; De la Plaza-Llamas R critically reviewed; Ramia JM critically reviewed, finally approved and supervised the report.
Conflict-of-interest statement: We have no financial relationships to disclose. Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Alba Manuel-Vázquez, MD, PhD, Doctor, Department of General and Digestive Surgery, University Hospital of Guadalajara, Calle Donante de sangre s/n, Guadalajara1 9002, Spain.
Telephone: +34-949-209200 Fax: +34-949-209218
Received: April 6, 2018
Peer-review started: April 8, 2018
First decision: April 21, 2018
Revised: April 26, 2018
Accepted: May 6, 2018
Article in press: May 6, 2018
Published online: May 14, 2018

The major symptoms of advanced hepatopancreatic-biliary cancer are biliary obstruction, pain and gastric outlet obstruction (GOO). For obstructive jaundice, surgical treatment should de consider in recurrent stent complications. The role of surgery for pain relief is marginal nowadays. On the last, there is no consensus for treatment of malignant GOO. Endoscopic duodenal stents are associated with shorter length of stay and faster relief to oral intake with more recurrent symptoms. Surgical gastrojejunostomy shows better long-term results and lower re-intervention rates, but there are limited data about laparoscopic approach. We performed a systematic review of the literature, according PRISMA guidelines, to search for articles on laparoscopic gastrojejunostomy for malignant GOO treatment. We also report our personal series, from 2009 to 2017. A review of the literature suggests that there is no standardized surgical technique either standardized outcomes to report. Most of the studies are case series, so level of evidence is low. Decision-making must consider medical condition, nutritional status, quality of life and life expectancy. Evaluation of the patient and multidisciplinary expertise are required to select appropriate approach. Given the limited studies and the difficulty to perform prospective controlled trials, no study can answer all the complexities of malignant GOO and more outcome data is needed.

Keywords: Duodenal obstruction, Gastrojejunostomy, Gastroenterosmy, Gastric outlet obstruction, Gastric bypass, Laparoscopy, Laparoscopic surgery, Sytematic review

Core tip: Both non-operative endoscopic approach and surgical treatment are available for palliative treatment of gastric outlet obstruction due to advanced hepatopancreatic-biliary cancer. Stent is usually preferred in patients with poor general condition or short life expectancy. Laparoscopic gastrojejunostomy is a feasible, safe and efficient technical option. Given the limited studies, we performed a systematic review of laparoscopic gastrojejunostomy in patients with advanced hepatopancreatic-biliary malignancy. Clinical prospective trials comparing different approaches with adequate sample size are warranted.