Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3527–3533 | Cite as

Clinical Outcome and Indications for Palliative Gastrojejunostomy in Unresectable Advanced Gastric Cancer: Multi-Institutional Retrospective Analysis

  • Atsushi Takeno
  • Shuji Takiguchi
  • Junya Fujita
  • Shigeyuki Tamura
  • Hiroshi Imamura
  • Kazumasa Fujitani
  • Jin Matsuyama
  • Masaki Mori
  • Yuichiro Doki
  • Clinical Study Group of Osaka University (CSGO), Upper GI Group
Gastrointestinal Oncology

Abstract

Background

Palliative gastrojejunostomy (GJJ) for gastric outlet obstruction (GOO) associated with unresectable advanced gastric cancers (UAGC) is the most commonly used treatment modality, but its indication remains controversial. In this multi-institutions study, we investigated the clinical outcome of GJJ for UAGC and predictors of outcome and survival.

Methods

A retrospective analysis was performed on 211 patients who underwent palliative GJJ for GOO caused by UAGC from 29 institutions between 2007 and 2009. Operative outcome including postoperative morbidity, mortality, assessment of oral intake by GOO Scoring System (GOOSS) and survival time were recorded. Prognostic factors for overall survival and risk factors for hospital death were investigated by univariate and multivariate analyses.

Results

Postoperative oral food intake was recorded in 203 (96 %) patients. The average GOOSS improved from 1.1 at baseline to 2.5 at 1 month after surgery and remained above 2 for up to 6 months. Overall morbidity, 30-day mortality and hospital death rates were 22, 6 and 11 %, respectively. Median survival time was 228 days and 1-year survival rate was 31 %. Poor performance status (PS), prior chemotherapy and high C-reactive protein (CRP) level were significant independent predictors of poor survival. Poor PS and high CRP were also identified as significant risk factors of hospital death.

Conclusions

Palliative GJJ is beneficial for GOO caused by UAGC in terms of improvement of oral food intake, with acceptable morbidity and mortality. However, its indication for patients with poor PS, high CRP level, and a history of chemotherapy is less clear.

References

  1. 1.
    Otsuji E, Yamaguchi T, Sawai K, Hagiwara A, Taniguchi H, Takahashi T. Recent advances in surgical treatment have improved the survival of patients with gastric carcinoma. Cancer. 1998;82:1233–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Ohtsu A. Chemotherapy for metastatic gastric cancer: past, present, and future. J Gastroenterol. 2008;43:256–64.PubMedCrossRefGoogle Scholar
  3. 3.
    Kaminishi M, Yamaguchi H, Shimizu N, et al. Stomach-partitioning gastrojejunostomy for unresectable gastric carcinoma. Arch Surg. 1997;132:184–7.PubMedCrossRefGoogle Scholar
  4. 4.
    Kikuchi S, Tsutsumi O, Kobayashi N, et al. Does gastrojejunostomy for unresectable cancer of the gastric antrum offer satisfactory palliation? Hepatogastroenterology. 1999;46:584–7.PubMedGoogle Scholar
  5. 5.
    Nakata Y, Kimura K, Tomioka N, Sato M, Watanabe Y, Kawachi K. Gastric exclusion for unresectable gastric cancer. Hepatogastroenterology. 1999;46:2654–7.PubMedGoogle Scholar
  6. 6.
    Kwon SJ, Lee HG. Gastric partitioning gastrojejunostomy in unresectable distal gastric cancer patients. World J Surg. 2004;28:365–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Stupart DA, Panieri E, Dent DM. Gastrojejunostomy for gastric outlet obstruction in patients with gastric carcinoma. S Afr J Surg. 2006;44:52–4.PubMedGoogle Scholar
  8. 8.
    Choi YB. Laparoscopic gatrojejunostomy for palliation of gastric outlet obstruction in unresectable gastric cancer. Surg Endosc. 2002;16:1620–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Navarra G, Musolino C, Venneri A, De Marco ML, Bartolotta M. Palliative antecolic isoperistaltic gastrojejunostomy: a randomized controlled trial comparing open and laparoscopic approaches. Surg Endosc. 2006;20:1831–4.PubMedCrossRefGoogle Scholar
  10. 10.
    Adler DG, Baron TH. Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients. Am J Gastroenterol. 2002;97:72–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Fiori E, Lamazza A, Volpino P, et al. Palliative management of malignant antro-pyloric strictures. Gastroenterostomy vs. endoscopic stenting. A randomized prospective trial. Anticancer Res. 2004;24:269–71.PubMedGoogle Scholar
  12. 12.
    Mehta S, Hindmarsh A, Cheong E, et al. Prospective randomized trial of laparoscopic gastrojejunostomy versus duodenal stenting for malignant gastric outflow obstruction. Surg Endosc. 2006;20:239–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Jeurnink SM, Steyerberg EW, van Hooft JE, et al; Dutch SUSTENT Study Group. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc. 2010;71:490–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Sano T, Sasako M, Yamamoto S, et al. Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy. Japan Clinical Oncology Group study 9501. J Clin Oncol. 2004;22:2767–73.PubMedCrossRefGoogle Scholar
  15. 15.
    Hosono S, Ohtani H, Arimoto Y, Kanamiya Y. Endoscopic stenting versus surgical gastroenterostomy for palliation of malignant gastroduodenal obstruction: a meta-analysis. J Gastroenterol. 2007;42:283–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Nagao J. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreatico-biliary malignancies. Endoscopy. 2004;36:73–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Jeurnink SM, van Eijck CH, Steyerberg EW, et al. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18–27.PubMedCrossRefGoogle Scholar
  18. 18.
    Lien YC, Hsieh CC, Wu YC, et al. Preoperative serum albumin level is a prognostic indicator for adenocarcinoma of the gastric cardia. J Gastrointest Surg. 2004;8:1041–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lee J, Lim T, Uhm JE, et al. Prognostic model to predict survival following first-line chemotherapy in patients with metastatic gastric adenocarcinoma. Ann Oncol. 2007;18:886–91.PubMedCrossRefGoogle Scholar
  20. 20.
    McMillan DC. An inflammation-based prognostic score and its role in the nutrition-based management of patients with cancer. Proc Nutr Soc. 2008;67:257–62.PubMedCrossRefGoogle Scholar
  21. 21.
    Fearon KC, Voss AC, Hustead DS. Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr. 2006;83:1345–50.PubMedGoogle Scholar
  22. 22.
    Crumley AB, Stuart RC, McKernan M, McMillan DC. Is hypoalbuminemia an independent prognostic factor in patients with gastric cancer? World J Surg. 2010;34:2393–8.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Atsushi Takeno
    • 1
  • Shuji Takiguchi
    • 2
  • Junya Fujita
    • 3
  • Shigeyuki Tamura
    • 1
  • Hiroshi Imamura
    • 4
  • Kazumasa Fujitani
    • 5
  • Jin Matsuyama
    • 6
  • Masaki Mori
    • 2
  • Yuichiro Doki
    • 2
  • Clinical Study Group of Osaka University (CSGO), Upper GI Group
  1. 1.Department of SurgeryKansai Rosai HospitalAmagasakiJapan
  2. 2.Department of Gastroenterological Surgery, Graduate School of MedicineOsaka UniversitySuitaJapan
  3. 3.Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
  4. 4.Department of SurgerySakai City HospitalSakaiJapan
  5. 5.Department of SurgeryOsaka National HospitalOsakaJapan
  6. 6.Department of SurgeryYao Municipal HospitalOsakaJapan

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