Palliative distal gastrectomy offers no survival benefit over gastrojejunostomy for gastric cancer with outlet obstructi
- PDF / 520,242 Bytes
- 7 Pages / 595.276 x 793.701 pts Page_size
- 112 Downloads / 189 Views
WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
Palliative distal gastrectomy offers no survival benefit over gastrojejunostomy for gastric cancer with outlet obstruction: retrospective analysis of an 11-year experience Yasuhiro Okumura1*, Hiroharu Yamashita1, Susumu Aikou1, Koichi Yagi1, Yukinori Yamagata1, Masato Nishida1, Kazuhiko Mori1, Sachiyo Nomura1, Joji Kitayama2, Toshiaki Watanabe2 and Yasuyuki Seto1
Abstract Background: Either palliative distal gastrectomy or gastrojejunostomy are the initial treatment options for locally advanced gastric cancer with outlet obstruction when curative-intent resection is not feasible. Since chemotherapy is the mainstay for unresectable gastric cancer, the clinical value of palliative distal gastrectomy is controversial. Methods: We retrospectively reviewed the clinical data of patients with gastric cancer with outlet obstruction treated at our institution between January 2002 and December 2012. We compared the clinical outcomes of palliative distal gastrectomy with those of gastrojejunostomy patients and the factors affecting overall survival were evaluated. Results: Elective palliative distal gastrectomy and gastrojejunostomy were performed in 18 and 25 patients, respectively. The median overall survival times in the gastrojejunostomy and palliative distal gastrectomy groups were statistically equivalent at 8.8 and 8.3 months, respectively (P = 0.73), despite the more locally advanced tumors in the gastrojejunostomy as compared with the palliative distal gastrectomy group. A multivariate Cox regression analysis showed absence of postoperative chemotherapy and higher postoperative complication grade to be associated with worse clinical outcomes. Conclusions: Palliative distal gastrectomy offers neither survival nor palliative benefit as compared to gastrojejunostomy. Minimizing the morbidity of intervention for outlet obstruction, followed by chemotherapy, appears to be the optimal initial strategy for incurable gastric cancer with outlet obstruction. Keywords: Gastric cancer with outlet obstruction, Gastrojejunostomy, Palliative distal gastrectomy
Background Gastric cancer with outlet obstruction (GCOO) is a locally advanced malignancy characterized by tumor ingrowth. GCOO is also associated with outward tumor growth and invasion, as evidenced by 47% of GCOO showing direct invasion of adjacent organs [1]. More importantly, GCOO frequently metastasizes to lymph nodes (93%), the peritoneum (34%), and the liver (15%) [1], suggesting a systemically advanced tumor. Patients with GCOO had worse clinical outcomes than those without outlet obstruction even after curative resection [2]. * Correspondence: [email protected] 1 Department of Gastrointestinal Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan Full list of author information is available at the end of the article
Although chemotherapy is generally the mainstay for treatment of advanced disease, the symptoms associated with GCOO, such as nausea, vomiting, and poor nutrition
Data Loading...
