Question:
A 60-year-old male patient has antral carcinoma which is spreading to the head of the pancreas and multiple small metastases to the right lobe of the liver. What will be the best treatment?
A 60-year-old male patient has antral carcinoma which is spreading to the head of the pancreas and multiple small metastases to the right lobe of the liver. What will be the best treatment?
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With distant metastases, curative resection is impossible; focus on palliative bypass of the obstructed gastric outlet.
Updated On: Jun 23, 2026
- Whipple's surgery
- Gastrectomy + Right lobectomy
- Gastrojejunostomy
- Palliative care
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The Correct Option is C
Solution and Explanation
Step 1: Assess resectability. The patient has antral (gastric antrum) carcinoma with: (i) local spread to head of pancreas and (ii) distant hepatic metastases (multiple, right lobe). The presence of distant metastases (liver) makes the disease stage IV (metastatic) -- surgical cure is not possible.
Step 2: Analyze each surgical option. Whipple's procedure (pancreaticoduodenectomy) is performed for resectable pancreatic head or periampullary tumors -- not indicated here as the primary is gastric with unresectable metastases. Gastrectomy + right lobectomy would be an extensive surgery in a patient with multiple liver metastases -- not justified as it does not achieve cure. Palliative care alone (option D) is appropriate for very debilitated patients but does not address specific surgical palliation of obstructive complications.
Step 3: Identify the palliative surgical option. Gastrojejunostomy is a bypass procedure that relieves gastric outlet obstruction. In antral carcinoma, the tumor commonly obstructs the pylorus and duodenum. When the disease is unresectable but the patient develops or is at risk of duodenal obstruction, gastrojejunostomy is the surgical palliative procedure of choice -- bypassing the obstruction to allow oral intake and improve quality of life. The PDF explanation states: duodenal obstruction occurs in approximately 15% of cases; surgical bypass by gastrojejunostomy is performed.
Conclusion: With unresectable antral carcinoma (hepatic metastases), gastrojejunostomy provides the best palliative surgical relief of gastric outlet obstruction.
Step 2: Analyze each surgical option. Whipple's procedure (pancreaticoduodenectomy) is performed for resectable pancreatic head or periampullary tumors -- not indicated here as the primary is gastric with unresectable metastases. Gastrectomy + right lobectomy would be an extensive surgery in a patient with multiple liver metastases -- not justified as it does not achieve cure. Palliative care alone (option D) is appropriate for very debilitated patients but does not address specific surgical palliation of obstructive complications.
Step 3: Identify the palliative surgical option. Gastrojejunostomy is a bypass procedure that relieves gastric outlet obstruction. In antral carcinoma, the tumor commonly obstructs the pylorus and duodenum. When the disease is unresectable but the patient develops or is at risk of duodenal obstruction, gastrojejunostomy is the surgical palliative procedure of choice -- bypassing the obstruction to allow oral intake and improve quality of life. The PDF explanation states: duodenal obstruction occurs in approximately 15% of cases; surgical bypass by gastrojejunostomy is performed.
Conclusion: With unresectable antral carcinoma (hepatic metastases), gastrojejunostomy provides the best palliative surgical relief of gastric outlet obstruction.
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