Impact of carcinomatosis and ascites status on long-term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: Stent placement versus palliative gastrojejunostomy

Chan Hyuk Park, Jun Chul Park, Eun Hye Kim, Hyunsoo Chung, Ji Yeong An, Hyoung Il Kim, Sung Kwan Shin, Sang Kil Lee, Jae Ho Cheong, Woo Jin Hyung, Yong Chan Lee, Sung Hoon Noh, Choong Bae Kim

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24 Citations (Scopus)

Abstract

Background Self-expandable metal stent (SEMS) placement and palliative gastrojejunostomy (GJJ) are palliative treatment options for malignant gastric outlet obstruction. Objective To compare clinical outcomes of palliative treatments for gastric outlet obstruction caused by unresectable gastric cancer. Design Retrospective study. Setting University-affiliated tertiary-care hospital in the Republic of Korea. Patients Two hundred fifty-six patients with gastric outlet obstruction caused by unresectable gastric cancer. Intervention SEMS placement and palliative GJJ. Main Outcome Measurements Patency duration and overall survival duration. Results In total, 217 and 39 patients underwent SEMS placement and palliative GJJ, respectively, as an initial palliative treatment. Treatment modality affected reobstruction after clinical success (hazard ratio [HR] [95% confidence interval {CI}], 0.5 [0.3-0.8] of palliative GJJ). In addition, carcinomatosis with ascites was an independent associated factor of clinical success and reobstruction (HR [95% CI], 0.3 [0.1-0.7] and 1.4 [1.0-2.0], respectively). In a subgroup of patients with good performance who had neither carcinomatosis nor ascites, patency duration and overall survival duration did not differ between the 2 groups (P =.079 and P =.290, respectively). In patients with good performance who had carcinomatosis without ascites, patency duration was longer in the palliative GJJ group than in the SEMS placement group (P =.016). Overall survival, however, did not differ between the 2 groups (P =.062). In a subgroup of patients with good performance who had carcinomatosis with ascites, both patency duration and overall survival were longer in the palliative GJJ group than in the SEMS placement group (P =.007 and P =.012, respectively). Limitations Nonrandomized, retrospective study. Conclusion Long-term clinical outcomes of the palliative treatment modality for gastric outlet obstruction caused by unresectable gastric cancer were affected by carcinomatosis and ascites status.

Original languageEnglish
Pages (from-to)321-332
Number of pages12
JournalGastrointestinal endoscopy
Volume81
Issue number2
DOIs
Publication statusPublished - 2015 Feb 1

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Gastroenterology

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