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Carcinomatosis matters: clinical outcomes and prognostic factors for clinical success of stent placement in malignant gastric outlet obstruction

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Abstract

Background

Although carcinomatosis is not a contraindication to stenting in selected patients with malignant gastric outlet obstruction (GOO), associate factors for clinical success rate of self-expandable metallic stent (SEMS) placement in GOO patients with carcinomatosis have not been fully characterized.

Methods

We analyzed a total 228 patients who were scheduled for SEMS placement for malignant GOO in tertiary-care academic medical center. All patients were treated with an uncovered or covered SEMS by using the over-the-wire placement procedure. We retrospectively evaluated clinical outcomes of SEMS placement.

Results

Technical success was achieved in all patients. Patients were categorized into two groups according to the presence of carcinomatosis. Clinical success rates of patients without carcinomatosis group and with carcinomatosis group were 93.9 % (92 of 98) and 80.8 % (105 of 130), respectively (P = 0.004). In subgroup analysis of patients with carcinomatosis, the clinical success rate was lower in patients with ascites (64.8 %) than in those without ascites (92.1 %, P < 0.001). Multivariate logistic regression model revealed that carcinomatosis without ascites did not decrease clinical success rate compared with absence of carcinomatosis; meanwhile, carcinomatosis with ascites showed lower clinical success rates compared with absence of carcinomatosis (adjusted odds ratio 0.163, 95 % confidence interval 0.058–0.461). In addition, poor performance status [Eastern Cooperative Oncology Group (ECOG) status ≥3, adjusted odds ratio 0.178, 95 % confidence interval 0.078–0.409] was also an independent poor predictive factor for clinical success of SEMS placement.

Conclusions

In palliation for malignant GOO, the status of carcinomatosis with ascites and poor performance status (ECOG status ≥3) are significant predictive factors for poor clinical success of SEMS placement.

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Disclosures

Han Ho Jeon, Chan Hyuk Park, Jun Chul Park, Choong Nam Shim, Sunyong Kim, Hyun Jik Lee, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee, and Yong Chan Lee have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Yonsei Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea

    Han Ho Jeon, Chan Hyuk Park, Jun Chul Park, Choong Nam Shim, Sunyong Kim, Hyun Jik Lee, Hyuk Lee, Sung Kwan Shin, Sang Kil Lee & Yong Chan Lee

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  1. Han Ho Jeon
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  2. Chan Hyuk Park
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  3. Jun Chul Park
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  4. Choong Nam Shim
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  7. Hyuk Lee
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  9. Sang Kil Lee
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  10. Yong Chan Lee
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Corresponding author

Correspondence to Jun Chul Park.

Additional information

Han Ho Jeon, Chan Hyuk Park contributed equally to this work.

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Jeon, H.H., Park, C.H., Park, J.C. et al. Carcinomatosis matters: clinical outcomes and prognostic factors for clinical success of stent placement in malignant gastric outlet obstruction. Surg Endosc 28, 988–995 (2014). https://doi.org/10.1007/s00464-013-3268-x

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  • DOI: https://doi.org/10.1007/s00464-013-3268-x

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