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Effectiveness of laparoscopic stomach-partitioning gastrojejunostomy for patients with gastric outlet obstruction caused by advanced gastric cancer

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Abstract

Background

Distal advanced gastric cancer (AGC) occasionally causes gastric outlet obstruction (GOO). We developed a laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ) to restore the ability of food intake.

Methods

This was a retrospective study performed at a single institution. Of consecutive 78 patients with GOO caused by AGC between 2006 and 2012, 43 patients who underwent LSPGJ were enrolled. The procedure was performed in an antiperistaltic Billroth II fashion, and the afferent loop was elevated and fixed along the staple line of the proximal partitioned stomach. Then, patients for whom R0 resection was planned received chemotherapy prior to laparoscopic gastrectomy. The primary end point was food intake at the time of discharge, which was evaluated using the GOO scoring system (GOOSS). Short- and long-term outcomes were assessed as secondary end points. Overall survival was estimated and compared between the groups who received neoadjuvant chemotherapy followed by surgery (NAC group), definitive chemotherapy followed by curative resection (Conversion group), and best supportive care (BSC group).

Results

The median operative time was 92 min, blood loss did not exceed 30 g in any patient, and postoperative complications (Clavien–Dindo grade ≥2) were only seen in four patients (9.3 %). The median time to food intake was 3 days, and GOOSS scores were significantly improved in 41 patients (95.3 %). Chemotherapy was administered to 38 patients (88.4 %), of whom 11 later underwent radical resection, and 4 of 11 patients underwent conversion surgery following definitive chemotherapy. Median survival times were significantly superior in the NAC (n = 7; 46.8 months) and Conversion (n = 4; 35.9 months) groups than in the BSC group (n = 26; 12.2 months); however, the difference was not significant between the Conversion and NAC groups.

Conclusions

LSPGJ is a feasible and safe minimally invasive induction surgery for patients with GOO from surgical and oncological perspectives.

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Abbreviations

AGC:

Advanced gastric cancer

GOO:

Gastric outlet obstruction

LSPGJ:

Laparoscopic stomach-partitioning gastrojejunostomy

GOOSS:

GOO scoring system

NAC:

Neoadjuvant chemotherapy

BSC:

Best supportive care

SPGJ:

Stomach-partitioning gastrojejunostomy

ELS:

Endoscopic linear stapler

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Acknowledgments

The authors would like to thank Enago (www.enago.jp) for the English language review.

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This work was not supported by any grant or funding.

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Authors and Affiliations

  1. Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan

    Tsuyoshi Tanaka, Koichi Suda, Kazuki Inaba, Yoshinori Ishida & Ichiro Uyama

  2. Department of Surgery, Himeji Medical Center, Himeji, Japan

    Seiji Satoh

  3. Department of Surgery, Kokura Memorial Hospital, Kitakyushu, Japan

    Yuichiro Kawamura

Authors
  1. Tsuyoshi Tanaka
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  2. Koichi Suda
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  6. Yoshinori Ishida
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Correspondence to Koichi Suda.

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Disclosures

Tsuyoshi Tanaka, Koichi Suda, Seiji Satoh, Yuichiro Kawamura, Kazuki Inaba, Yoshinori Ishida, and Ichiro Uyama have no conflict of interests or financial ties to disclose.

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Tanaka, T., Suda, K., Satoh, S. et al. Effectiveness of laparoscopic stomach-partitioning gastrojejunostomy for patients with gastric outlet obstruction caused by advanced gastric cancer. Surg Endosc 31, 359–367 (2017). https://doi.org/10.1007/s00464-016-4980-0

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