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Is Palliative Gastrojejunostomy for Malignant Gastric Outlet Obstruction an Optimal Choice for Very Elderly Patients? A Report from a Long-Lived Country

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Gastrojejunostomy (GJ) is a surgical option for malignant gastric outlet obstruction (mGOO). Confronting an aging society, the demand to treat elderly cancer patients with unresectable malignancies is increasing; however, the benefit of GJ to the very elderly (≥ 80 years of age) has never been investigated.

Methods

This multicenter, retrospective review included 108 patients who had undergone GJ for mGOO from two medical centers in Japan, one of the most long-lived countries. Patients were divided into two groups, with 80 years of age as the cut-off. Various factors, including surgical complications and patient survival, were compared.

Results

GJ in the very elderly (aged ≥ 80 years) was associated with a higher incidence of surgical complications (p = 0.049), such as delayed gastric emptying (DGE; p < 0.001), aspiration pneumonia (p = 0.029), and consequent mortality (p = 0.016). Age ≥80 years was also identified as an independent predictor of DGE (odds ratio 6.444, p = 0.005) and survival after GJ (hazard ratio 7.767, p = 0.016). In particular, the median survival time after GJ in the population aged ≥80 years with gastric cancer was only < 2 months. About the surgical procedure, antiperistaltic anastomosis with partial stomach partitioning (PSP) yielded the lowest occurrence rate of DGE (3.4%) and aspiration pneumonia (1.7%).

Conclusions

GJ does not seem to be the optimal choice for very elderly patients, particularly those with gastric cancer. If performed, antiperistaltic anastomosis with PSP should be employed to reduce the surgical complications.

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Acknowledgment

The authors are grateful to the administrative staff at both West and General Hospitals for calculating the medical costs.

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Authors and Affiliations

  1. Department of Surgery, Kobe City Medical Center West Hospital, Hyogo, Japan

    Siyuan Yao PhD, Kana Ishikawa MD, Takashi Kumode MD, Keisuke Tanino MD, Ryosuke Mizuno MD, Yugo Matsui MD, Shusaku Honma PhD, Teppei Murakami PhD, Takatsugu Kan PhD, Sanae Nakajima PhD & Takehisa Harada MD

  2. Department of Surgery, Kobe City Medical Center General Hospital, Hyogo, Japan

    Ryosuke Kita MD & Satoshi Kaihara PhD

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  1. Siyuan Yao PhD
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Correspondence to Siyuan Yao PhD.

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Disclosures

Siyuan Yao, Ryosuke Kita, Kana Ishikawa, Takashi Kumode, Keisuke Tanino, Ryosuke Mizuno, Yugo Matsui, Shusaku Honma, Teppei Murakami, Takatsugu Kan, Sanae Nakajima, Satoshi Kaihara, and Takehisa Harada declare they have no conflicts of interest related to this article.

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Yao, S., Kita, R., Ishikawa, K. et al. Is Palliative Gastrojejunostomy for Malignant Gastric Outlet Obstruction an Optimal Choice for Very Elderly Patients? A Report from a Long-Lived Country. Ann Surg Oncol 30, 313–321 (2023). https://doi.org/10.1245/s10434-022-12599-6

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  • DOI: https://doi.org/10.1245/s10434-022-12599-6

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