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Park YE. Is vagotomy necessary in palliative surgery for incurable advanced gastric cancer?: a retrospective case-control study. World J Surg Oncol 2023; 21:213. [PMID: 37480111 PMCID: PMC10360296 DOI: 10.1186/s12957-023-03111-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The interplay between the nervous system and cancer plays an important role in the initiation and progression of gastric cancer. Few studies have presented evidence that the sympathetic nervous system inhibits the occurrence and development of gastric cancer while the parasympathetic nervous system promotes the growth of gastric cancer. To investigate the effect of vagotomy, which is the resection of a parasympathetic nerve innervating the stomach, on the progression of gastric cancer, a retrospective study was conducted comparing the prognosis of simple palliative gastrojejunostomy (PGJ) and palliative gastrojejunostomy with vagotomy (PGJV). METHODS From January 01, 2000, to December 31, 2021, the medical records of patients who underwent PGJ or PGJV because of gastric outlet obstruction due to incurable advanced gastric cancer at the Yeungnam University Medical Center were retrospectively reviewed. Patients were divided into two groups: locally unresectable gastric cancer (LUGC) or gastric cancer with distant metastasis (GCDM), according to the reason for gastrojejunostomy, and factors affecting overall survival (OS) were analyzed. RESULTS There was no significant difference in surgical outcomes and postoperative complications between the patients with PGJV and patients with PGJ. In univariate analysis, vagotomy was not a significant factor for OS in the GCDM group (HR 1.14, CI 0.67-1.94, p value 0.642), while vagotomy was a significant factor for OS in the LUGC group (HR 0.38, CI 0.15-0.98, p value 0.045). In multivariate analysis, when vagotomy is performed together with PGJ for LUGC, the OS can be significantly extended (HR 0.25, CI 0.09-0.068, p value 0.007). CONCLUSIONS When PGJ for LUGC was performed with vagotomy, additional survival benefits could be achieved with low complication risk. However, to confirm the effect of vagotomy on the growth of gastric cancer, further prospective studies using large sample sizes are essential.
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Affiliation(s)
- Yong-Eun Park
- Department of Surgery, Yeungnam University Medical Center, 170 Hyeonchungno, Nam-Gu, Daegu, 42415, Korea.
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2
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Single center consecutive series cohort study of partial stomach-partitioning gastrojejunostomy for gastric outlet obstruction. Asian J Surg 2021; 45:326-331. [PMID: 34158203 DOI: 10.1016/j.asjsur.2021.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/28/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/OBJECTIVE Gastric outlet obstruction can have a large impact on quality of life for patients with upper gastrointestinal cancer or benign obstruction. Partial stomach-partitioning gastrojejunostomy has previously shown promising outcomes compared to conventional gastrojejunostomy in terms of reduced delayed gastric emptying. The objective of the current study was to present outcomes of partial stomach-partitioning gastrojejunostomy in a single high-volume center for upper gastrointestinal cancer. METHODS A retrospective cohort study including all consecutive patients who underwent partial stomach-partitioning gastrojejunostomy from 2013 to 2020. The primary outcome was oral intake tolerance. A subgroup analysis was performed in all patients with manifest gastric outlet obstruction comparing partial stomach-partitioning gastrojejunostomy to conventional gastrojejunostomy. RESULTS Partial stomach-partitioning gastrojejunostomy was performed in 32 patients and laparoscopic technique was used in 19 patients (59%). The procedure improved oral intake tolerance defined by gastric outlet obstruction scoring system by 0.63 points on average (P = 0.041). No postoperative complications related to the procedure were observed. Recurrence of gastric outlet obstruction developed in six patients (19%), four patients (13%) required endoscopic reintervention but no patient required surgical reintervention. A comparison between partial stomach-partitioning gastrojejunostomy and conventional gastrojejunostomy showed no statistically significant differences regarding postoperative nutritional status, length of hospital stay, recurrence or reintervention. CONCLUSION The results of the study show that partial stomach-partitioning gastrojejunostomy can be an effective surgical treatment for patients suffering from gastric outlet obstruction and that the procedure can be safely performed with laparoscopic technique.
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Nakamichi N, Tsujiura M, Matsui T, Yamamoto T, Yoshioka A, Hiramoto H, Ouchi Y, Ishimoto T, Kosuga T, Mochizuki S, Nakashima S, Bamba M, Masuyama M, Otsuji E. The therapeutic strategy for advanced gastric cancer with pyloric stenosis and liver metastasis; successfully treated by gastro-jejunal bypass and chemotherapy first, followed by curative R0 resection. Surg Case Rep 2021; 7:6. [PMID: 33409765 PMCID: PMC7788145 DOI: 10.1186/s40792-020-00979-7] [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: 07/23/2020] [Accepted: 09/18/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The indication of surgical resection for liver metastasis from gastric cancer (GC) is still limited and controversial because of its more aggressive oncological characteristics than liver metastasis from colorectal cancer. Pyloric stenosis causes an inadequate oral intake and malnutrition in GC patients. We herein report a case of GC with these two factors that was successfully treated by the combination of gastro-jejunal bypass and chemotherapy, followed by curative R0 resection. CASE PRESENTATION A 60-year-old man was diagnosed with type 2 GC with liver metastasis and pyloric stenosis, which was confirmed as the HER2-positive type. He underwent gastrojejunostomy and received capecitabine and cisplatin (XP) + trastuzumab chemotherapy. After three courses of the XP + trastuzumab regimen, shrinkage of the primary lesion and liver metastasis was confirmed and his nutritional parameters markedly improved with a stable oral intake after bypass surgery. He underwent curative R0 resection by distal gastrectomy with D2 lymphadenectomy and partial hepatectomy. Histologically, viable tumor cells were observed in less than one-third of the primary lesion, and only scar tissue without viable cancer cells was noted in the resected liver specimen. His postoperative course was uneventful, and recurrence has not been detected in the 30 months after surgery without adjuvant chemotherapy. CONCLUSION The present case report describes a successful strategy for advanced GC with pyloric stenosis and liver metastasis.
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Affiliation(s)
- Naosuke Nakamichi
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Masahiro Tsujiura
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan.
| | - Tomohiro Matsui
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Taiga Yamamoto
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
| | - Ayana Yoshioka
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Hidekazu Hiramoto
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Yoshimi Ouchi
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Takeshi Ishimoto
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Toshiyuki Kosuga
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Satoshi Mochizuki
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Susumu Nakashima
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Masamichi Bamba
- Department of Diagnostic Pathology, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Mamoru Masuyama
- Department of Surgery, Saiseikai Shiga Hospital, 2-4-1 Ohashi, Ritto, Shiga, 520-3046, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto, Kyoto, 602-8566, Japan
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4
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Lorusso D, Giliberti A, Bianco M, Lantone G, Leandro G. Stomach-partitioning gastrojejunostomy is better than conventional gastrojejunostomy in palliative care of gastric outlet obstruction for gastric or pancreatic cancer: a meta-analysis. J Gastrointest Oncol 2019; 10:283-291. [PMID: 31032096 DOI: 10.21037/jgo.2018.10.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Unresectable gastric or pancreatic malignancies are the most common cause of gastric outlet obstruction (GOO). Although several authors reported better outcomes in patients submitted to gastric partitioning gastrojejunostomy (GPGJ) compared to conventional gastrojejunostomy (CGJ), clinical experience with GPGJ is poor, studies comparing the two techniques are few and no randomized trials were performed. Our systematic review aimed at comparing GPGJ (partial or complete) with CGJ in patients operated for GOO for gastric or pancreatic cancer. Methods A computerized literature search was performed on Medline until January 2017. The studies included were 8 with a total of 226 patients. Study outcomes included delayed gastric emptying (DGE), nutrition by oral intake, length of hospital stay and survival time. The pooled effects were estimated using a fixed effect model or random effect model based on the heterogeneity test. Results were expressed as odds ratio (OR) and 95% confidence interval (CI) for dichotomous outcomes. For continuous outcomes, the mean of the measures of central tendency was calculated. Results The GPGJ group had lower rates of DGE (OR =4.997, 95% CI: 2.310-10.810) and length of hospital stay (19.7 versus 23.3 days) and higher rates of nutrition by oral intake (OR =0.156, 95% CI: 0.055-0.442) and survival time (189.2 versus 115.2 days). Conclusions GPGJ is associated with lower rates of DGE and higher rates of normal oral intake compared to CGJ with a tendency towards better survival in the GPGJ group. Multicenter randomized controlled trials would be required to confirm these results.
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Affiliation(s)
- Dionigi Lorusso
- Surgery Unit, National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | - Aurore Giliberti
- Trial Center, National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | - Margherita Bianco
- Trial Center, National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | - Giulio Lantone
- Surgery Unit, National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
| | - Gioacchino Leandro
- Trial Center, National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy.,Gastroenterology Unit, National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy
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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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Maeda Y, Shinohara T, Katayama T, Minagawa N, Sunahara M, Nagatsu A, Futakawa N, Hamada T. A laparoscopic approach is associated with a decreased incidence of SSI in patients undergoing palliative surgery for malignant bowel obstruction. Int J Surg 2017; 42:90-94. [PMID: 28456709 DOI: 10.1016/j.ijsu.2017.04.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/09/2017] [Accepted: 04/15/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Several authors have reported on the utility of a laparoscopic approach for the palliation of malignant bowel obstruction (MBO); however, the advantages of laparoscopic surgery for MBO have not yet been confirmed. METHODS We retrospectively reviewed the medical records of patients who underwent palliative surgery for MBO between 2007 and 2015. Laparoscopic procedures have been performed when technically possible since 2014. Successful palliation was defined as the ability to tolerate solid food (TSF) for at least 2 weeks. RESULTS Twenty-two patients underwent laparoscopic palliative surgery, and 171 patients underwent conventional open palliative surgery to relieve the symptoms of MBO. Laparoscopic palliative surgery was performed for patients with MBO due to colorectal cancer (n = 12), uterine cancer (n = 3), and other types of cancers (including gastric, prostate, and renal cancer). The following laparoscopic procedures were performed: stoma placement (n = 18), palliative resection (n = 3) and bypass (n = 2). The median operative time was 100 min and the median operative blood loss was 9 ml. The laparoscopic palliative operation allowed 91% (20/22) of the patients to consume a solid diet for more than 2 weeks, and be discharged from hospital. There were no significant differences between laparoscopic surgery and open surgery with regard to the ability to TSF or the postoperative mortality rate. The postoperative morbidity (Clavien-Dindo Grade ≥ II) rates in the laparoscopic and open surgery groups were 14% and 32%, respectively. Laparoscopic surgery led to a significantly lower rate of postoperative surgical site infection (SSI) in comparison to open surgery (4.5% vs 32%; P = 0.0053). CONCLUSION A laparoscopic approach in palliative surgery for MBO was safe and feasible, and was associated with a lower incidence of SSIs. By minimizing the postoperative morbidity rate, the laparoscopic approach may provide significant benefits to patients with MBO who have a limited life expectancy.
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Affiliation(s)
- Yoshiaki Maeda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan.
| | - Toshiki Shinohara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Tomonari Katayama
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Masao Sunahara
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Akihisa Nagatsu
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Noriaki Futakawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
| | - Tomonori Hamada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Japan
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Fernández-Moreno MC, Martí-Obiol R, López F, Ortega J. Modified Devine Exclusion for Unresectable Distal Gastric Cancer in Symptomatic Patients. Case Rep Gastroenterol 2017; 11:9-16. [PMID: 28203132 PMCID: PMC5301114 DOI: 10.1159/000452759] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 12/21/2022] Open
Abstract
Background In patients with outlet obstruction syndrome and/or severe anemia secondary to unresectable gastric cancer (GC), partial stomach-partitioning gastrojejunostomy, or modified Devine exclusion, is a surgical alternative. Methods A retrospective study was conducted on patients with unresectable distal GC treated with modified Devine exclusion as palliative surgery between February 2005 and December 2015. It consisted of a series of 10 patients with outlet obstruction syndrome and/or severe anemia. The outcomes of this technique were based on oral tolerance, blood transfusions, postoperative complications, and survival. Results Early oral tolerance and a low rate of blood transfusions were observed postoperatively. There was no postoperative mortality and a very low complication rate without anastomotic leakage. Median survival was 9 months. Conclusions Partial stomach-partitioning gastrojejunostomy is a safe procedure for unresectable GC which can improve the quality of life of these patients.
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Affiliation(s)
| | | | - Fernando López
- Department of Surgery, Clinical University Hospital, Valencia, Spain; Department of Surgery, University of Valencia, Valencia, Spain
| | - Joaquín Ortega
- Department of Surgery, Clinical University Hospital, Valencia, Spain; Department of Surgery, University of Valencia, Valencia, Spain
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Kumagai K, Rouvelas I, Ernberg A, Persson S, Analatos A, Mariosa D, Lindblad M, Nilsson M, Ye W, Lundell L, Tsai JA. A systematic review and meta-analysis comparing partial stomach partitioning gastrojejunostomy versus conventional gastrojejunostomy for malignant gastroduodenal obstruction. Langenbecks Arch Surg 2016; 401:777-85. [PMID: 27339200 DOI: 10.1007/s00423-016-1470-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 06/16/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE Partial stomach partitioning gastrojejunostomy (PSPGJ) was introduced as a palliative treatment for malignant gastric outlet obstruction (MGO) caused by unresectable gastric or periampullary cancers and suggested to offer advantages over conventional gastrojejunostomy (CGJ) in reducing the risk for delayed gastric emptying (DGE). However, insufficient evidence is available to allow a comprehensive view of the true value of PSPGJ. The present study aimed to show the advantages of PSPGJ in terms of alleviating DGE and improving postoperative recovery compared to CGJ. METHODS A systematic literature search was performed, and studies comparing DGE and other perioperative and postoperative data including operation time, blood loss, total postoperative complications, anastomotic leak, postoperative period before oral intake, and/or hospital stay between PSPGJ and CGJ for MGO were incorporated. Risk ratio (RR) for binary variables and weighted mean difference (WMD) for continuous variables were calculated, and meta-analyses were performed. RESULTS Seven studies containing 207 patients were included. The risk for DGE was significantly lower after PSPGJ (RR 0.32; 95%CI 0.17 to 0.60; P < 0.001). PSPGJ significantly reduced the postoperative hospital stay (WMD -6.1 days; 95%CI -8.9 to -3.3 days; P < 0.001). No significant differences were observed in the other variables between the groups. CONCLUSIONS PSPGJ for MGO seems to offer significant advantages in terms of alleviating DGE and improving postoperative recovery compared to CGJ.
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Affiliation(s)
- Koshi Kumagai
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
| | - Ioannis Rouvelas
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Annika Ernberg
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Saga Persson
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Apostolos Analatos
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Daniela Mariosa
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lindblad
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Nilsson
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Lundell
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jon A Tsai
- Center for Digestive Diseases, Karolinska University Hospital and Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Eguchi H, Yada K, Shibata K, Matsumoto T, Etoh T, Yasuda K, Inomata M, Shiraishi N, Ohta M, Kitano S. Laparoscopic stomach-partitioning gastrojejunostomy is an effective palliative procedure to improve quality of life in patients with malignant gastroduodenal outlet obstruction. Asian J Endosc Surg 2012; 5:153-6. [PMID: 22994415 DOI: 10.1111/j.1758-5910.2012.00151.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 06/26/2012] [Accepted: 07/03/2012] [Indexed: 01/10/2023]
Abstract
INTRODUCTION A patient with gastroduodenal obstruction caused by an unresectable gastroduodenal or periampullary cancer cannot ingest food and/or liquid. The patient's quality of life rapidly deteriorates, resulting in a dismal prognosis. Stomach-partitioning gastrojejunostomy has been previously reported, and here, we evaluate the laparoscopic procedure. METHODS We performed laparoscopic stomach-partitioning gastrojejunostomy in 18 patients with unresectable gastroduodenal or periampullary cancers. Data on operation time, blood loss, complications, and postoperative course were retrospectively collected. RESULTS The mean operation time was 152 min, and conversion to open surgery was not required in any patients. Postoperative complications occurred in three patients (17%) and included cholangitis, anastomotic ulcer hemorrhage, and enterocolitis. The mean time to oral intake was 4.5 days, and the mean and median duration of oral intake were maintained for 133 and 88 days, respectively. CONCLUSION Laparoscopic stomach-partitioning gastrojejunostomy is a safe and effective procedure that allows patients with gastroduodenal outlet obstruction to eat again and improve the quality of their remaining life.
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Affiliation(s)
- Hidetoshi Eguchi
- Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan
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10
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Is modified Devine exclusion necessary for gastrojejunostomy in patients with unresectable pancreatobiliary cancer? Surg Today 2010; 41:97-100. [PMID: 21191698 DOI: 10.1007/s00595-009-4246-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 10/30/2009] [Indexed: 01/15/2023]
Abstract
PURPOSE Gastrojejunostomy is often performed as palliative surgery for unresectable pancreatobiliary cancer. Modified Devine exclusion (MDE) is a technical variation of gastrojejunostomy, which partially separates the mid-portion of the stomach. We conducted this study to assess whether MDE is necessary for gastrojejunostomy in patients with unresectable pancreatobiliary cancer. METHODS We compared the postoperative results of MDE (n = 26) with those of conventional gastrojejunostomy (CGJ; n = 20) performed palliatively for unresectable pancreatobiliary cancers. RESULTS The morbidity rates were 38% after MDE and 50% after CGJ, with 23% and 40% of patients suffering delayed gastric emptying, respectively. Two of the CGJ group patients could never eat again. Modified Devine exclusion slowed the progression of anemia in all of the patients with duodenal bleeding. CONCLUSION Modified Devine exclusion may be effective for patients with unresectable pancreatobiliary cancer.
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Oida T, Mimatsu K, Kawasaki A, Kano H, Kuboi Y, Amano S. Modified Devine exclusion with vertical stomach reconstruction for gastric outlet obstruction: a novel technique. J Gastrointest Surg 2009; 13:1226-32. [PMID: 19333659 DOI: 10.1007/s11605-009-0874-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 03/12/2009] [Indexed: 01/31/2023]
Abstract
BACKGROUND A gastroenterostomy is the most commonly performed palliative procedure in patients with gastroduodenal outflow obstruction (GOO) caused by unresectable advanced gastric and pancreatic cancer. We developed a new technique--modified Devine exclusion with vertical stomach reconstruction--and evaluated the efficacy of this procedure. METHODS We retrospectively studied 60 patients who underwent gastrojejunostomy for GOO caused by unresectable advanced gastric and pancreatic cancer. These patients were divided into two groups, the conventional gastrojejunostomy group (CGJ group) and the modified Devine exclusion with vertical stomach reconstruction group (MDVSR group). RESULTS The mean duration of the required nasogastric suction, the number of days after which diet could be initiated and after which oral ingestion of solid food could by safely resumed, and the duration of hospitalization after the surgery were significantly shorter in the MDVSR group. The patients in the MDVSR group had a significantly longer duration of stay at home and survival after the surgery. Moreover, in the MDVSR group, GOO did not recur in any of the patients until the time of death. CONCLUSION We consider that our procedure of modified Devine exclusion with vertical stomach reconstruction is an easy and feasible technique for GOO.
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Affiliation(s)
- Takatsugu Oida
- Department of Surgery, Social Insurance Yokohama Central Hospital, 268 Yamashita-cho, Naka-ku, Yokohama, 231-8553, Yokohama, Japan.
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12
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Smith RA, Bosonnet L, Ghaneh P, Sutton R, Evans J, Healey P, Garvey C, Hughes M, Raraty M, Campbell F, Neoptolemos JP. The platelet-lymphocyte ratio improves the predictive value of serum CA19-9 levels in determining patient selection for staging laparoscopy in suspected periampullary cancer. Surgery 2008; 143:658-66. [PMID: 18436014 DOI: 10.1016/j.surg.2007.12.014] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2007] [Accepted: 12/20/2007] [Indexed: 12/21/2022]
Abstract
BACKGROUND The objective of this study was to identify whether the preoperative platelet-lymphocyte (P/L) ratio might improve the predictive value of CA19-9 levels in stratifying a patient group with suspected periampullary malignancy who do not require staging laparoscopy. METHODS Patients with suspected periampullary cancer were identified from a prospectively maintained 10-year database. Only patients with resectable disease who underwent staging laparoscopy and subsequent laparotomy were included. Low-risk groups were stratified using a CA19-9 cutoff value of < or = 150 kU/l (or < or = 300 kU/l in patients with a concurrent bilirubin concentration > 35 micromol/l) and a P/L ratio value of < or = 150. RESULTS From 263 patients, preoperative CA19-9 levels and P/L ratios were available in 216 and 225 patients, respectively. The positive and negative predictive values for resectability, sensitivity, and specificity for CA19-9 levels < or = 150 kU/l were 83%, 36%, 51%, and 73%, respectively. For P/L ratios < or = 150, these levels were 81%, 38%, 51%, and 72%, respectively. When combining the requirement for both CA19-9 levels and P/L ratios to be < or = 150 (n = 38 out of 183), both positive predictive value (95%) and specificity (96%) were improved (Fisher exact test, P =.065 and P < .001, respectively); 21% of laparoscopies were avoidable when using these criteria. Increasing T stage (P = .005), vascular invasion (P < .001), perineural invasion (P = .008), and resection margin involvement (P < .001) were all associated with greater preoperative P/L ratios in resected periampullary adenocarcinoma (n = 204). CONCLUSIONS The preoperative P/L ratio reflects an index of tumor invasiveness and merits prospective evaluation as an adjunct to CA19-9 in determining the requirement for laparoscopic staging in patients with potentially resectable periampullary malignancy.
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Affiliation(s)
- Richard A Smith
- Division of Surgery and Oncology, School of Cancer Studies, University of Liverpool, Liverpool, UK.
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