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Prognostic Scoring System for Patients Who Present with a Gastric Outlet Obstruction Caused by Advanced Pancreatic Adenocarcinoma

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Abstract

Background

Gastroenterostomy and stent placement are the most common palliative procedures for patients with a gastric outlet obstruction caused by advanced pancreatic adenocarcinoma. Gastroenterostomy is regarded as the optimum treatment for patients in whom a longer survival is expected, while stent placement is preferred for patients whose survival is likely to be relatively short. However, prognosis of such patients has not been fully evaluated.

Methods

This study included patients undergoing gastroenterostomy or duodenal stent placement for gastric outlet obstruction caused by advanced pancreatic adenocarcinoma between 2002 and 2015. Prognostic factors found to be significant based on a multivariate analysis were given a prognostic score according to their hazard ratios (HR). The overall survivals stratified according to the total prognostic score were compared.

Results

The median survival time of all cohorts was 4.2 months. The multivariate analyses demonstrated a neutrophil-to-lymphocyte ratio (NLR) ≥ 4 (HR = 4.01, p < 0.001), presence of liver metastases (HR = 1.90, p = 0.002), and presence of cancer pain (HR = 2.08, p < 0.001) to be significant prognostic factors. Regarding the HR, NLR ≥ 4, liver metastases and cancer pain were subsequently scored as 2, 1, and 1, respectively. The median survival time was 9.4 months in patients with a score of 0 or 1 and 3.3 months in patients with a score of 2–4, respectively.

Conclusion

The scoring system clearly demonstrates the patient survival. Patients with scores of 0 or 1 are favorable candidates for gastroenterostomy, while patients with scores of 2–4 are candidates for stent placement.

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 411-8777, Japan

    Teiichi Sugiura, Yukiyasu Okamura, Takaaki Ito, Yusuke Yamamoto, Ryo Ashida & Katsuhiko Uesaka

  2. Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan

    Yukio Yoshida & Masaki Tanaka

Authors
  1. Teiichi Sugiura
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  2. Yukiyasu Okamura
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  3. Takaaki Ito
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  4. Yusuke Yamamoto
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  5. Ryo Ashida
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  6. Yukio Yoshida
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  7. Masaki Tanaka
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  8. Katsuhiko Uesaka
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Corresponding author

Correspondence to Teiichi Sugiura.

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Sugiura, T., Okamura, Y., Ito, T. et al. Prognostic Scoring System for Patients Who Present with a Gastric Outlet Obstruction Caused by Advanced Pancreatic Adenocarcinoma. World J Surg 41, 2619–2624 (2017). https://doi.org/10.1007/s00268-017-4027-2

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  • DOI: https://doi.org/10.1007/s00268-017-4027-2

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