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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2013

01-10-2013 | Gastrointestinal Oncology

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

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

Published in: Annals of Surgical Oncology | Issue 11/2013

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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.
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Metadata
Title
Clinical Outcome and Indications for Palliative Gastrojejunostomy in Unresectable Advanced Gastric Cancer: Multi-Institutional Retrospective Analysis
Authors
Atsushi Takeno, MD, PhD
Shuji Takiguchi, MD, PhD
Junya Fujita, MD, PhD
Shigeyuki Tamura, MD, PhD
Hiroshi Imamura, MD, PhD
Kazumasa Fujitani, MD, PhD
Jin Matsuyama, MD, PhD
Masaki Mori, MD, PhD
Yuichiro Doki, MD, PhD
Clinical Study Group of Osaka University (CSGO), Upper GI Group
Publication date
01-10-2013
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 11/2013
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-3033-3

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