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Hai NV, Thong DQ, Dat TQ, Nguyen DT, Quoc HLM, Minh TA, Anh NVT, Vuong NL, Trung TT, Bac NH, Long VD. Stomach-partitioning versus conventional gastrojejunostomy for unresectable gastric cancer with gastric outlet obstruction: A propensity score matched cohort study. Am J Surg 2024; 228:206-212. [PMID: 37827868 DOI: 10.1016/j.amjsurg.2023.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND Stomach partitioning gastrojejunostomy (SPGJ) was introduced to deal with delayed gastric emptying (DGE). This study aimed to compare the short- and long-term outcomes of SPGJ versus conventional gastrojejunostomy (CGJ). METHOD This cohort study analyzed 108 patients who underwent gastrojejunostomy for unresectable gastric cancer: 70 patients underwent SPGJ, and 38 patients underwent CGJ between 2018 and 2022. Propensity score-matched (PSM) analysis was used to balance the baseline characteristics. RESULTS After PSM, there were 26 patients in each group. SPGJ group had significantly lower incidence of DGE (3.8% vs. 34.6%), vomiting (3.8% vs. 42.3%), and prokinetics requirement (11.5% vs. 46.2%). SPGJ group had significantly shorter time to solid diet tolerance (4.1 days vs. 5.7 days) and postoperative hospital stay (7.7 days vs. 9.3 days). There was no significant difference in relapse reinterventions, gastric outlet obstruction (GOO) recurrence, conversion surgery, and survival outcomes. CONCLUSIONS SGPJ was associated with lower rate of DGE, prokinetics requirement, and shorter time of solid diet tolerance compared to CGJ in the treatment of unresectable gastric cancer patients with GOO.
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Affiliation(s)
- Nguyen Viet Hai
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam
| | - Dang Quang Thong
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam
| | - Tran Quang Dat
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam
| | - Doan Thuy Nguyen
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam
| | - Ho Le Minh Quoc
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam
| | - Tran Anh Minh
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam; Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Vu Tuan Anh
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Tran Thien Trung
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Hoang Bac
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam; Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Vo Duy Long
- Department of Gastro-Intestinal Surgery, University of Medical Center at Ho Chi Minh City at Ho Chi Minh City, Viet Nam; Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
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Xu F, Zhang H, Fan Z, Zheng Z, Sun A, Zhang J. Investigating biomechanical alterations and emptying patterns after various gastrojejunostomy strategy. Food Res Int 2024; 176:113815. [PMID: 38163719 DOI: 10.1016/j.foodres.2023.113815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/22/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
Gastrojejunostomy is a prominent approach in managing distal gastric cancer that is unresectable due to gastric outlet obstruction (GOO). Research has demonstrated that stomach-partitioning gastrojejunostomy (SPGJ) exhibits superior clinical efficacy compared to conventional gastrojejunostomy (CGJ), however, the underlying mechanism of this phenomenon remains elusive. This study constructed 3D models of the SPGJ and CGJ based on the computed tomography (CT) images obtained from a patient diagnosed with distal gastric cancer. The biomechanical patterns of these procedures in the digestive system were subsequently compared through numerical simulations and in vitro experiments. The results of the numerical simulation demonstrated that the model following SPGJ promoted the discharge of food through the anastomotic orifice and into the lower jejunum. Furthermore, a decrease in passage size after partitioning, the low-level velocity of esophageal, and an increase in contents viscosity effectively inhibited the flow through the passage to the pylorus, ultimately reducing stimulation to tumor. The study also revealed that favorable gastric emptying is associated with a smaller passage and faster inlet velocity, and that lower contents viscosity. The experimental findings conducted in vitro demonstrated that SPGJ exhibited superior efficacy in obstructing the flow near the pylorus in comparison to CGJ. Moreover, a decrease in passage size correlates with a reduction in fluid flow towards the pylorus. These results provide the foundation of theory and practice for the surgical management of patients with GOO resulting from unresectable distal gastric cancer, and have potential implications for clinical interventions.
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Affiliation(s)
- Fengyan Xu
- School of Mechanical Engineering, Jiangsu University of Technology, Changzhou, Jiangsu, China
| | - Haiqiao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenmin Fan
- School of Mechanical Engineering, Jiangsu University of Technology, Changzhou, Jiangsu, China.
| | - Zhi Zheng
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, China
| | - Jun Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Han X, Kong D, He X, Xie S, Li C. A meta-analysis of the effect of laparoscopic gastric resection on the surgical site wound infection in patients with advanced gastric cancer. Int Wound J 2023; 20:4300-4307. [PMID: 37493021 PMCID: PMC10681515 DOI: 10.1111/iwj.14332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/11/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
By conducting a meta-analysis of relevant clinical studies on the treatment of advanced gastric cancer (GC) using laparoscopic and open surgeries, we aimed to evaluate the impact of these two surgical approaches on postoperative surgical site infections (SSIs) in patients with advanced GC. We aimed to provide evidence-based support for preventing SSIs in postoperative patients with advanced GC. From database establishment until May 2023, we systematically searched PubMed, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, and Wanfang Data databases for relevant studies comparing laparoscopic and open surgeries for the treatment of advanced GC. Two researchers independently performed the literature screening and data extraction based on predefined inclusion and exclusion criteria. The meta-analysis was conducted using STATA 17.0. Twenty articles involving 3084 patients met the inclusion criteria, including 1462 patients in the laparoscopic group and 1622 cases in the open surgery group. The meta-analysis results revealed that the incidence of postoperative SSIs was significantly lower in the laparoscopic group than in the open surgery group (odds ratio = 0.341, 95% confidence interval: 0.219-0.532, p < 0.001). The current evidence indicates that laparoscopic radical gastrectomy can significantly reduce the incidence of postoperative site infections in patients with advanced GC.
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Affiliation(s)
- Xue Han
- Internal Medicine DepartmentZhongshan Dongsheng HospitalZhongshanChina
| | - Defeng Kong
- Department of Critical Care MedicineBeijing Changping District HospitalBeijingChina
| | - Xuefeng He
- Internal Medicine DepartmentZhongshan Dongsheng HospitalZhongshanChina
| | - Shiyu Xie
- Internal Medicine DepartmentZhongshan Dongsheng HospitalZhongshanChina
| | - Chunlin Li
- Department of Intervention TherapyCancer Hospital of Shantou University Medical CollegeShantouChina
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Ma L, Zhao B, Zhang Y, Jing S, Qu H. Multimodality Therapy, Followed by Laparoscopic Gastrectomy, for Unresectable Gastric Cancer With Outlet Obstruction and Bulky N2 Metastases. Surg Laparosc Endosc Percutan Tech 2023; 33:645-651. [PMID: 38053324 DOI: 10.1097/sle.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/19/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Patients who have gastric cancer with outlet obstruction (GCOO) and bulky N2 metastases cannot undergo curative resection and tolerate chemotherapy poorly, which may be improved by multimodality therapy (MMT) combined with laparoscopic gastrectomy. PATIENTS AND METHODS The records of patients with GCOO and bulky N2 metastases who received MMT including nasojejunal feeding combined with preoperative chemotherapy (PCT), followed by laparoscopic exploration [enteral nutritional (EN) group] in sequence or laparoscopic gastrojejunostomy (LGJ) before PCT plus laparoscopic gastrectomy (LGJ group) were retrospectively reviewed. Prognostic Nutritional Index, gastric outlet obstruction scoring system grade, quality of life, response to PCT, surgical outcomes, and long-term survival were analyzed. RESULTS Fifty-four consecutive patients with GCOO and bulky N2 metastases were identified. The Prognostic Nutritional Index and Nutritional Risk Screening-2002 score of patients were significantly improved as a result of multimodal therapy, but no superiority was demonstrated between the EN group and the LGJ group. The quality of life (52.6 ± 11.4 vs 68.2 ± 13.5, P = 0.036) and gastric outlet obstruction scoring system (P < 0.05) of patients in the LGJ group were better compared with the EN group. The rate of laparoscopic D2 gastrectomy (94.3% vs 92.9%, P = 0.64) and R0 resection (91.4% vs 92.9%, P = 0.53) in the EN group was similar to the LGJ group. There were no significant differences for the 5-year overall survival rate (63.2% vs 57.1, P = 0.86) and the 5-year relapse-free survival rate (42.9% vs 53.8%, P = 0.54) of patients in the EN group compared with the LGJ group. CONCLUSIONS MMT including EN support or laparoscopic gastrojejunostomy followed by laparoscopic D2 gastrectomy is a feasible and effective treatment for patients with GCOO and bulky N2 metastases.
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Affiliation(s)
- Liangang Ma
- Department of General Surgery, Affiliated Beijing Chaoyang Hospital of Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China
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Wang C, Zhang X, Liu Y, Lin S, Yang C, Chen B, Li W. Efficacy and long-term prognosis of gastrojejunostomy for malignant gastric outlet obstruction: A systematic review and Bayesian network meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106967. [PMID: 37385941 DOI: 10.1016/j.ejso.2023.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/18/2023] [Accepted: 06/20/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Gastrojejunostomy (GJ) is becoming a standard surgical treatment for ameliorating malignant gastric outlet obstruction (MGOO). However, data on the long-term outcomes of MGOO treatment are lacking. This network meta-analysis aimed to compare overall survival (OS) rates and subsequent anticancer treatment outcomes of GJwith other therapies in MGOO. METHODS We searched four electronic databases, including PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials, from inception to August 1, 2022. Studies reporting OS associated with GJ versus other treatments for MGOO were selected. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome assessed was OS, whereas the secondary outcome was subsequent anticancer treatment. We performed a Bayesian network meta-analysis to produce hazard ratios (HR) and odds ratios (OR) with 95% credible intervals (CrIs). RESULTS We identified 24 retrospective studies that included 2473 patients. The studies assessed the outcomes of six treatments to alleviate MGOO. Results showed that GJ (hazard ratio: 0.83, 95% CrI: 0.78-0.88) was the most effective treatment for patients with MGOO, with the greatest surface under the cumulative ranking curve (SUCRA) values (79.9%) versus non-resection, palliative chemotherapy (13.9%) in terms of OS. Similarly, GJ (SUCRA: 46.5%) improved subsequent anticancer treatment requirements, ranking second only to jejunostomy/gastrostomy (JT/GT) (SUCRA: 95.9%). CONCLUSIONS Our study demonstrates that GJ improves OS and follow-up treatments versus other non-resection treatments in patients with MGOO. These findings may serve for selecting appropriate therapy for MGOO.
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Affiliation(s)
- Chuandong Wang
- Department of Thyroid and Breast Surgery, Xiamen Humanity Hospital Fujian Medical University, Xiamen, 361006, China; Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Xiaojuan Zhang
- Department of Radiology, Xiamen Humanity Hospital Fujian Medical University, Xiamen, 361006, China
| | - Yi Liu
- Endoscopic Center, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, China; Department of Endoscopy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100021, China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China; Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China; Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China
| | - Bing Chen
- Department of Thyroid and Breast Surgery, Xiamen Humanity Hospital Fujian Medical University, Xiamen, 361006, China.
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China; Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, China.
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Ye R, Wang C, Hu B, Guan G. Safety and efficacy of laparoscopic digestive tract nutrition reconstruction combined with conversion therapy for patients with unresectable and obstructive gastric cancer. Front Oncol 2023; 13:1175580. [PMID: 37361593 PMCID: PMC10285493 DOI: 10.3389/fonc.2023.1175580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Background To explore the safety, efficacy, and survival benefits of laparoscopic digestive tract nutrition reconstruction (LDTNR) combined with conversion therapy in patients with unresectable gastric cancer with obstruction. Methods The clinical data of patients with unresectable gastric cancer with obstruction who was treated in Fujian Provincial Hospital from January 2016 to December 2019, were analyzed. LDTNR was performed according to the type and degree of obstruction. All patients received the epirubicin + oxaliplatin + capecitabine regimen as conversion therapy. Results Thirty-seven patients with unresectable obstructive gastric cancer underwent LDTNR, while thirty-three patients received chemotherapy only. In LDTNR group patients, the proportion of nutritional risks gradually decreased, the rate of severe malnutrition decreased, the proportion of neutrophil-lymphocyte ratio (NLR) <2.5 increased, the proportion of prognosis nutrition index (PNI) ≥45 increased, and the Spitzer QOL Index significantly increased at day 7 and 1 month postoperatively (P<0.05). One patient (6.3%) developed grade III anastomotic leakage and was discharged after the endoscopic intervention. The median chemotherapy cycle of patients in LDTNR group was 6 cycles (2-10 cycles), higher than that in Non-LDTNR group (P<0.001). Among those who received LDTNR therapy, 2 patients had a complete response, 17 had a partial response, 8 had stable disease, and 10 had progressive disease, which was significantly better than the response rate in Non-LDTNR group(P<0.001). The 1-year cumulative survival rates of the patients with or without LDTNR were 59.5% and 9.1%. The 3-year cumulative survival rate with or without LDTNR was 29.7% and 0%, respectively (P<0.001). Conclusions LDTNR can improve the inflammatory and immune status, increase compliance with chemotherapy, and have potential benefits in improving the safety and effectiveness of and survival after conversion treatment.
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Affiliation(s)
- Rong Ye
- Department of Colorectal Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Bo Hu
- Department of Gastrointestinal Surgery, Xiamen Humanity Hospital Fujian Medical University, Xiamen, China
| | - Guoxian Guan
- Department of Colorectal Surgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Department of Colorectal Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Abdominal Surgery Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, China
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Fujimoto G, Kusanagi H, Hayashi K, Miyazaki A, Honjo H, Nakagi M. Impact of gastrectomy for incurable advanced gastric cancer in urgent situations in the elderly. Asian J Surg 2023; 46:514-519. [PMID: 35725798 DOI: 10.1016/j.asjsur.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chemotherapy is the standard treatment for incurable advanced gastric cancer; however, its indications are limited in elderly patients. Furthermore, the efficacy of chemotherapy and surgery as well as the treatment strategy for incurable gastric cancer in elderly patients with urgent conditions are unclear. In these situations, palliative gastrectomy or gastrojejunostomy is often performed. Less invasive surgical procedures should be performed on elderly patients in consideration of their condition; however, gastrectomy may be preferable if it can improve the prognosis. Therefore, we investigated the significance of palliative gastrectomy in elderly patients with incurable advanced gastric cancer who underwent surgery due to stenosis or bleeding. METHODS Fifty-six patients aged >80 years with stage IV incurable advanced gastric cancer who underwent surgery at our department between February 1992 and July 2021 were included in the study. The patients underwent gastrectomy (distal and total gastrectomy) or gastrojejunostomy. We examined the association between the clinicopathological factors and overall survival after surgery. RESULTS The subjects included 43 men and 13 women. Twenty-nine patients underwent distal gastrectomy or total gastrectomy, and 27 underwent gastrojejunostomy. The median follow-up duration for all patients was 297 days. The univariate analysis indicated significant differences in the surgical procedure and blood loss. Multivariate analysis showed a significant difference only in the surgical procedure (hazard ratio, 5.32; 95% confidence interval, 2.43-11.6; P < 0.001). CONCLUSIONS Gastrectomy as a palliative surgery for incurable advanced gastric cancer in elderly patients may improve their prognosis.
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Affiliation(s)
- Goshi Fujimoto
- Department of Gastroenterological Surgery, Koga Community Hospital, Yaizu, Shizuoka, Japan.
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Ken Hayashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Akinari Miyazaki
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hirotaka Honjo
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masafumi Nakagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
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Krishnamoorthi R, Bomman S, Benias P, Kozarek RA, Peetermans JA, McMullen E, Gjata O, Irani SS. Efficacy and safety of endoscopic duodenal stent versus endoscopic or surgical gastrojejunostomy to treat malignant gastric outlet obstruction: systematic review and meta-analysis. Endosc Int Open 2022; 10:E874-E897. [PMID: 35692924 PMCID: PMC9187371 DOI: 10.1055/a-1794-0635] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background and study aims Malignant disease accounts for up to 80 % of gastric outlet obstruction (GOO) cases, which may be treated with duodenal self-expanding metal stents (SEMS), surgical gastrojejunostomy (GJ), and more recently endoscopic-ultrasound-guided gastroenterostomy (EUS-GE). These three treatments have not been compared head-to-head in a randomized trial. Methods We searched the Embase and MEDLINE databases for studies published January 2015-February 2021 assessing treatment of malignant GOO using duodenal SEMS, endoscopic (EUS-GE) or surgical (laparoscopic or open) GJ. Efficacy outcomes assessed included technical and clinical success rates, GOO recurrence and reintervention. Safety outcomes included procedure-related bleeding or perforation, and stent-related events for the duodenal SEMS and EUS-GE arms. Results EUS-GE had a lower rate of technical success (95.3%) than duodenal SEMS (99.4 %) or surgical GJ (99.9%) ( P = 0.0048). For duodenal SEMS vs. EUS-GE vs. surgical GJ, rates of clinical success (88.9 % vs. 89.0 % vs. 92.3 % respectively, P = 0.49) were similar. EUS-GE had a lower rate of GOO recurrence based on limited data ( P = 0.0036), while duodenal SEMS had a higher rate of reintervention ( P = 0.041). Overall procedural complications were similar (duodenal SEMS 18.7 % vs. EUS-GE 21.9 % vs. surgical GJ 23.8 %, P = 0.32), but estimated bleeding rate was lowest ( P = 0.0048) and stent occlusion rate was highest ( P = 0.0002) for duodenal SEMS. Conclusions Duodenal SEMS, EUS-GE, and surgical GJ showed similar clinical efficacy for the treatment of malignant GOO. Duodenal SEMS had a lower procedure-related bleeding rate but higher rate of reintervention.
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Affiliation(s)
- Rajesh Krishnamoorthi
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Shivanand Bomman
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Petros Benias
- Division of Gastroenterology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, United States
| | - Richard A. Kozarek
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
| | - Joyce A. Peetermans
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
| | - Edmund McMullen
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
| | - Ornela Gjata
- Endoscopy Division, Boston Scientific Corporation, Marlborough, Massachusetts, United States
| | - Shayan S. Irani
- Department of Gastroenterology and Hepatology, Virginia Mason Medical Center, Seattle, Washington, United States
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Wang C, Zhang X, Lin S, Yang C, Zhou B, Mi Y, Ye R, Chen Y, Chen W, Lin X, Tan S, Zhou Y, Li W. Superiority of Laparoscopic Gastrojejunostomy Combined With Multimodality Therapy for Gastric Outlet Obstruction Caused by Advanced Gastric Cancer. Front Oncol 2022; 12:814283. [PMID: 35155250 PMCID: PMC8832489 DOI: 10.3389/fonc.2022.814283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Data are limited concerning the survival outcomes of patients with gastric outlet obstruction (GOO) caused by advanced gastric cancers according to laparoscopic gastrojejunostomy (LGJ) combined with multimodality therapy (MMT). Therefore, the purpose of this study was to examine the feasibility and efficacy of these therapies. METHODS This single-centered, retrospective analysis included data of 184 patients with GOO due to advanced gastric cancer (AGC). Treatment models were: laparoscopic gastrojejunostomy combined with multimodality therapy (LGJ+MMT), endoscopic metal stent placement combined with multimodality therapy (EMSP+MMT), and multimodality therapy (MMT). RESULTS Improved oral intake, better nutritional indices, and better response to chemotherapy were observed in the LGJ+MMT group. Subsequent gastrectomy was performed in 43 (61.4%) patients in the LGJ+MMT group, 23 (37.7%) in the EMSP+MMT group, and 11 (20.8%) in the MMT group (P<0.001). LGJ+MMT was associated with better long-term prognosis. As confirmed by propensity scores and multivariate analyses, the 3-year survival rates in the three treatment models were 31.4% with LGJ+MMT, 0% with EMSP+MMT, and 0% with MMT in conversion therapy, and 50.0% with LGJ+MMT, 33.3% with EMSP+MMT, and 23.5% with MMT in NAC. A forest plot revealed that LGJ+MMT was related to a decreased risk of death. CONCLUSIONS LGJ combined with MMT was associated with better nutritional status, higher rates of subsequent gastrectomy, and good prognosis. LGJ combined with MMT may improve the long-term survival of patients with GOO caused by AGC.
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Affiliation(s)
- Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - BiaoHuan Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yulong Mi
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Rong Ye
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yifan Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Weijie Chen
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaojun Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Song Tan
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Yuhang Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
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Wang C, Lin S, Zhang X, Li W. Laparoscopic gastrojejunostomy versus endoscopic stenting combined with conversion therapy for gastric outlet obstruction. Scand J Gastroenterol 2021; 56:1248-1254. [PMID: 34314303 DOI: 10.1080/00365521.2021.1956581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There have been no studies comparing laparoscopic gastrojejunostomy (LGJ) and endoscopic metal stent placement (EMSP) combined with conversion therapy for gastric outlet obstruction (GOO) due to incurable advanced gastric cancer (GC). Therefore, the present study examined the short- and long-term outcomes and compared their therapeutic effects. METHODS We retrospectively evaluated the clinical outcomes of 94 patients with GOO due to incurable advanced GC. Patients were assigned to the LGJ (n = 48) or EMSP (n = 46) groups. Multivariate analyses were conducted to identify the factors associated with overall survival. A propensity score-matched analysis was performed to avoid confounding bias. RESULTS Compared to the EMSP group, patients in the LGJ group had fewer postoperative complications, better nutritional and inflammatory status, and a lower positive rate of tumor markers (p < .05). Conversion surgery was performed in 23 and 11 patients in the LGJ and EMSP groups, respectively. The median survival time (MST) in the LGJ group was 13.2 months, compared to 6.8 months for the EMSP group (p < .0001). Propensity score analyses confirmed this result. The MST of patients receiving conversion surgery was significantly better than that of patients without surgery in both the LGJ and EMSP groups (LGJ group: 38.3 months versus 7.6 months; EMSP group: 19.2 months versus 5.3 months, respectively, p < .0001). Multivariate analysis identified treatment selection and conversion surgery as independent prognostic factors for overall survival. CONCLUSION LGJ is an effective and feasible alternative to conversion therapy in terms of short- and long-term outcomes.
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Affiliation(s)
- Chuandong Wang
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Shengtao Lin
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China.,Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, China
| | - Weihua Li
- Shengli Clinical Medical College, Fujian Medical University, Fuzhou, China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, China
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Wang C, Lin S, Zhang X, Yang C, Li W. Laparoscopic Gastrojejunostomy with Conversion Therapy in Gastric Outlet Obstruction Caused by Incurable Advanced Gastric Cancer. Cancer Manag Res 2021; 13:6847-6857. [PMID: 34512024 PMCID: PMC8420554 DOI: 10.2147/cmar.s322569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/14/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose The benefits of laparoscopic gastrojejunostomy (LGJ) combined with conversion therapy for malignant gastric outlet obstruction (GOO) caused by incurable advanced gastric cancer (AGC) are unclear. This study aimed to examine the feasibility and efficacy of LGJ followed by enteral nutrition and conversion therapy in malignant GOO. Patients and Methods The clinical outcomes for 66 patients with GOO due to incurable AGC were retrospectively evaluated. The patients were classified into multimodal therapy (LGJ, enteral nutrition, and chemotherapy, n = 35) and chemotherapy alone (n = 31) groups. Conversion surgery was defined as surgery aimed at R0 resection in initially incurable tumours. Results Compared to the chemotherapy group, multimodal therapy patients had improved oral intake, more chemotherapy cycles, better nutritional indices, less sarcopenia, and improved quality of life (QOL) post-treatment. Conversion surgery was performed in 17 multimodal therapy patients, with no perioperative mortality, and R0 resection achieved in 15 patients (88.2%). The median survival time of multimodal therapy patients was 16.7 months, compared to 4.5 months for chemotherapy patients. Multimodal therapy patients with conversion surgery had significantly longer overall survival than those without surgery (44.2 vs 8.5 months, respectively, P< 0.001). Multivariate analysis identified multimodal therapy and improved or stable QOL as independent prognostic factors. Conclusion Multimodal therapy was associated with better nutritional and metabolic status, a safely induced high conversion surgery rate with a high R0 resection rate, and a good prognosis. LGJ with enteral nutrition and conversion therapy may improve long-term survival in obstructive incurable AGC.
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Affiliation(s)
- Chuandong Wang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Shengtao Lin
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Xiaojuan Zhang
- Fuzong Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Radiology, 900th Hospital Logistic Support Forces of PLA, Fuzhou, 350001, People's Republic of China
| | - Changshun Yang
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China.,Department of Surgical Oncology, Fujian Provincial Hospital, Fuzhou, 350001, People's Republic of China
| | - Weihua Li
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, People's Republic of China
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Ishida H, Cho H, Tsuchida K, Onoyama H, Maezawa Y. Laparoscopic stomach-partitioning gastrojejunostomy in preparation for distal gastrectomy and Billroth-II reconstruction after neoadjuvant chemotherapy for advanced gastric cancer with gastric outlet obstruction: A case report. Asian J Endosc Surg 2020; 13:415-418. [PMID: 31364273 DOI: 10.1111/ases.12741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/24/2019] [Accepted: 07/11/2019] [Indexed: 12/26/2022]
Abstract
Gastrojejunostomy has been performed as a palliative treatment for unresectable, advanced gastric cancer patients with gastric outlet obstruction (GOO). However, its role before neoadjuvant chemotherapy (NAC) has not been established. We present the case of a 72-year-old man with distal advanced gastric cancer with GOO. Computed tomography showed para-aortic lymph node (PAN) metastasis without other distal metastasis. We performed laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ), which avoided new gastrojejunostomy reconstruction when performing distal gastrectomy after NAC. His oral intake improved after surgery and NAC was successfully administered on postoperative day 14, without surgical complications. After completion of NAC, the patient underwent radical distal gastrectomy with gastrojejunostomy reused as Billroth-II reconstruction. A histological examination revealed no residual cancer cells. LSPGJ, with partitioning on the expected resection line in distal gastrectomy after NAC, can be useful for treating advanced gastric cancer with GOO when NAC followed by curative gastrectomy is planned.
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Affiliation(s)
- Hiroyuki Ishida
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazuhito Tsuchida
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Haruna Onoyama
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yukio Maezawa
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Ramos MFKP, Barchi LC, de Oliveira RJ, Pereira MA, Mucerino DR, Ribeiro Jr U, Zilberstein B, Cecconello I. Gastric partitioning for the treatment of malignant gastric outlet obstruction. World J Gastrointest Oncol 2019; 11:1161-1171. [PMID: 31908721 PMCID: PMC6937443 DOI: 10.4251/wjgo.v11.i12.1161] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/03/2019] [Accepted: 10/03/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastric outlet obstruction (GOO) is one of the main complications in stage IV gastric cancer patients. This condition is usually managed by gastrojejunostomy (GJ). However, gastric partitioning (GP) has been described as an alternative to overcoming possible drawbacks of GJ, such as delayed gastric emptying and tumor bleeding.
AIM To compare the outcomes of patients who underwent GP and GJ for malignant GOO.
METHODS We retrospectively analyzed 60 patients who underwent palliative gastric bypass for unresectable distal gastric cancer with GOO from 2009 to 2018. Baseline clinicopathological characteristics including age, nutritional status, body mass index, and performance status were evaluated. Obstructive symptoms were graded according to GOO score (GOOS). Surgical outcomes evaluated included duration of the procedure, surgical complications, mortality, and length of hospital stay. Acceptance of oral diet after the procedure, weight gain, and overall survival were the long-term outcomes evaluated.
RESULTS GP was performed in 30 patients and conventional GJ in the other 30 patients. The mean follow-up was 9.2 mo. Forty-nine (81.6%) patients died during that period. All variables were similar between groups, with the exception of worse performance status in GP patients. The mean operative time was higher in the GP group (161.2 vs 85.2 min, P < 0.001). There were no differences in postoperative complications and surgical mortality between groups. The median overall survival was 7 and 8.4 mo for the GP and GJ groups, respectively (P = 0.610). The oral acceptance of soft solids (GOOS 2) and low residue or full diet (GOOS 3) were reached by 28 (93.3%) GP patients and 22 (75.9%) GJ patients (P = 0.080). Multivariate analysis demonstrated that GOOS 2 and GOOS 3 were the main prognostic factors for survival (hazard ratio: 8.90, 95% confidence interval: 3.38-23.43, P < 0.001).
CONCLUSION GP is a safe and effective procedure to treat GOO. Compared to GJ, it provides similar surgical outcomes with a trend to better solid diet acceptance by patients.
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Affiliation(s)
| | - Leandro Cardoso Barchi
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
| | - Rodrigo Jose de Oliveira
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
| | - Marina Alessandra Pereira
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
| | - Donato Roberto Mucerino
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
| | - Bruno Zilberstein
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
| | - Ivan Cecconello
- Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
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The Surgical Outcomes of Totally Laparoscopic Stomach-partitioning Gastrojejunostomy for Gastric Outlet Obstruction: A Retrospective, Cohort Study. Surg Laparosc Endosc Percutan Tech 2018; 28:e49-e53. [PMID: 29252935 DOI: 10.1097/sle.0000000000000501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND We have reported the effectiveness of laparoscopy-assisted stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (LASPGJ-RY) for gastric outlet obstruction (GOO). The aim of this study was to evaluate the surgical outcomes of totally laparoscopic stomach-partitioning gastrojejunostomy Roux-en-Y reconstruction (TLSPGJ-RY) for GOO. MATERIALS AND METHODS This retrospective study enrolled 19 consecutive patients with GOO. Surgical outcomes of LASPGJ-RY (LA group; n=8) and TLSPGJ-RY (TL group; n=11) between January 2004 and 2015 were compared. The patients' background characteristics, operative findings, postoperative complications, and period to starting postoperative chemotherapy were examined. RESULTS Eligible cases included 6 patients with gastric cancer, 4 with pancreatic cancer, 4 with duodenal cancer, 4 with urologic malignancies, and 1 with benign duodenal stenosis. The patients' background characteristics were not significantly different. In surgical outcomes, there were no significant differences in operating time, bleeding, complications (≥Clavien-Dindo grade IIIA), and postoperative hospital stay between the groups. The time to resume diet was significantly shorter in the TL group (median, 3 d; range, 3 to 6 d) than in the LA group (median, 5 d; range, 3 to 7 d; P=0.0093), and the number of patients who could receive chemotherapy after surgery was significantly higher in the TL group (P=0.039). CONCLUSIONS TLSPGJ-RY was a safe and feasible gastrojejunostomy procedure for GOO. TLSPGJ-RY might be useful for early resumption of oral intake after surgery.
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