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

The prognosis of locally advanced gastric cancer is poor even if radical gastrectomy with D2 lymphadenectomy is followed by adjuvant chemotherapy. Hence, neoadjuvant chemotherapy is performed to try to improve the prognosis, as it can significantly downstage the tumor and safely improve the R0 resection rate of patients. Herein, we report a case of locally advanced gastric cancer with pancreatic invasion and gastric outlet obstruction that showed a pathological complete response after neoadjuvant chemotherapy with S-1 and oxaliplatin (SOX). A 74-year-old man presented to our hospital with abdominal pain and pyloric stenosis. CT images revealed a cStage IVb, cT4b tumor in the pancreas, cN1, cM0. Therefore, we performed laparoscopic gastrojejunostomy, and the patient’s oral intake improved after surgery; we then administered neoadjuvant chemotherapy with SOX on postoperative day 18, without any surgical complications. After 3 courses of neoadjuvant chemotherapy, the patient underwent radical distal gastrectomy, thereby avoiding pancreatoduodenectomy. Histopathological examination of the resected sample revealed no residual cancer cells, indicating a pathological complete response. No recurrence has occurred for 1 year after surgery. Thus, neoadjuvant chemotherapy with SOX can help in tumor downstaging and may be a multipotent option for the treatment of locally advanced gastric cancer, such as cases with the invasion of other organs; this treatment can result in improved curability and avoid overinvasive surgery.

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A survival analysis of a prospective multicenter observational study of surgical palliation in patients treated for malignant gastric outlet obstruction caused by incurable advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.113 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 113-113

Author(s):

Masanori Terashima ◽

Kazumasa Fujitani ◽

Masahiko Ando ◽

Kentaro Sakamaki ◽

Ryohei Kawabata ◽

...

Keyword(s):

Gastric Cancer ◽

Survival Analysis ◽

Adjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Gastric Outlet Obstruction ◽

Outlet Obstruction ◽

Oral Intake ◽

Good Survival ◽

Malignant Gastric Outlet Obstruction ◽

Surgical Palliation

113 Background: We previously reported that surgical palliation maintained patients’ quality of life (QOL) while improving the solid food intake with an acceptable surgical safety in patients with malignant gastric outlet obstruction (GOO) caused by advanced gastric cancer. To elucidate the impact of the improvement in the QOL on the survival, we performed a survival analysis according to the changes in the QOL. Methods: Eligibility criteria included (1) no or liquids-only oral intake, (2) aged ≥20 , (3) surgically fit, (4) ECOG PS of 0-2, and (5) written informed consent. Patients underwent either palliative gastrectomy or gastrojejunostomy. Validated QOL instruments (EORTC QLQ-STO22 and EuroQol-5D) assessed the QOL at baseline, 2 weeks, 1 month, and 3 months following surgical palliation, and postoperative improvement in the oral intake was also evaluated. Univariate and multivariate survival analyses were performed according to baseline characteristics and changes in QOL 2 weeks, 1 month, and 3 months after the operation. Results: The median survival time in the 104 patients was 11.30 months. In the univariate analysis, the survival was significantly better in the patients who received gastrectomy, received adjuvant chemotherapy, had a better PS, and had a worse baseline EQ5D score. Changes in the QOL scores had no marked impact on the survival at 2 weeks and 1 month after operation. However, in patients with an improved or stable EQ5D score at 3 months post-surgery, the survival was significantly better (p = 0.0043). An improved oral intake on the GOO score system (GOOSS) had a positive impact on the survival. A multivariate analysis in the patients survived more than 3 months after the operation revealed that adjuvant chemotherapy, a better baseline PS, a worse baseline EQ5D, an improved or stable EQ5D score, and an improved oral intake on the GOOSS at 3 months after surgical palliation were independent prognostic factors. Conclusions: In patients who received surgical palliation for malignant GOO caused by advanced gastric cancer, an improved oral intake and QOL score at 3 months after operation predicted a good survival. Clinical trial information: 000023494.

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