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Relationship between initial management strategy and survival in patients with gastric outlet obstruction due to gastric cancer
Author(s) -
Blumenthaler Alisa N.,
Ikoma Naruhiko,
Blum Mariela,
Das Prajnan,
Minsky Bruce D.,
Mansfield Paul F.,
Ajani Jaffer A.,
Badgwell Brian D.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.26177
Subject(s) - medicine , hazard ratio , gastrectomy , proportional hazards model , surgery , gastric outlet obstruction , confidence interval , metastasis , cancer , gastroenterology
Background The optimal management of gastric outlet obstruction (GOO) due to gastric cancer (GC) is unclear. We examined the relationships between clinical and management variables and outcomes in patients with GC having GOO. Methods The GOO management and clinical course were reviewed in patients with GC and GOO. Cox regression and Kaplan‐Meier analyses were used to identify variables predictive of overall survival (OS). Results The study included 59 patients. Eleven had imaging evidence of metastasis and 35 had pathologically confirmed peritoneal disease. Initial management included resection in 23 patients, feeding jejunostomy ± decompressive gastrostomy (JT/GT) in 25, surgical gastrojejunostomy in five, and endoscopic intervention in six. Seven patients with initial JT/GT underwent resection after neoadjuvant therapy. Median OS (95% confidence interval [CI]) was 21.4 (0.0‐45.1) months in the upfront resection group (median follow‐up, 14.7 months) and not reached in those with initial JT/GT, neoadjuvant therapy, and later resection (median follow‐up, 26.5 months) ( P = .18). On multivariable analysis, clinically positive nodes (hazard ratio [HR]: 3.76; 95% CI, 1.17‐12.12; P = .03), metastasis on CT (HR: 3.97; 95% CI: 1.53‐10.26; P = .01), and resection (HR: 0.37; 95% CI: 0.17‐0.79; P = .01) independently predicted OS. Conclusion In GOO due to GC, OS is similar after treatment with upfront resection compared with JT/GT, neoadjuvant therapy, and later resection. Upfront JT/GT may allow patients to tolerate chemotherapy and improve selection for gastrectomy.