Yoshio Haga1, Naoki Hiki2, Takahiro Kinoshita3, Toshiyasu Ojima4, Yoshihiro Nabeya5, Shirou Kuwabara6, Yasuyuki Seto7, Kazuhito Yajima8, Hiroya Takeuchi9, Kazuhiro Yoshida10, Yasuhiro Kodera11, Yoshiyuki Fujiwara12, Hideo Baba13. 1. Department of Surgery, Japan Community Healthcare Organization Amakusa Central General Hospital, 101 Higashi-machi, Amakusa-shi, 8630033, Japan. haga-yoshio@amakusa.jcho.go.jp. 2. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan. 3. Gastric Surgery Division, National Cancer Center Hospital East, Kashiwa, Japan. 4. Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan. 5. Division of Esophago-Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan. 6. Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan. 7. Department of Gastrointestinal Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 8. Department of Surgery, Sainokuni Higashiomiya Medical Center, Saitamashi, Japan. 9. Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. 10. Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan. 11. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 12. Department, of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, Japan. 13. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Abstract
BACKGROUND: There are currently two treatment options for gastric outlet obstruction (GOO) due to gastric cancer, endoscopic stenting and surgical gastrojejunostomy. However, their therapeutic effects have not yet been established. Therefore, the present study was undertaken to examine these effects. METHODS: The Japanese Gastric Cancer Association invited its delegates to participate in a retrospective multicenter cohort study on patients with GOO due to gastric cancer who underwent stent therapy or gastrojejunostomy in 2015. RESULTS: We obtained data from 85 patients undergoing stent therapy and 94 undergoing gastrojejunostomy from 42 hospitals. Baseline data revealed that stent patients had lower food intake, poorer performance status, and worse prognostic indices than gastrojejunostomy patients. Postoperative food intake and survival times were worse in stent patients than in gastrojejunostomy patients. We performed propensity score matching to select pairs of patients with similar baseline characteristics in the two treatment groups. After matching, the frequency of postoperative complications was significantly less in stent patients (3%, 1/33) than in gastrojejunostomy patients (21%, 7/34; p = 0.03). A low residue or full diet was achieved by 97% of stent patients (32/33) and 97% of gastrojejunostomy patients (33/34) (p = 0.98). Median survival times were 7.8 months in stent patients and 4.0 months in gastrojejunostomy patients (p = 0.38). CONCLUSIONS: Propensity score matching demonstrated that endoscopic stent placement resulted in less postoperative morbidity than and a similar food intake and equivalent survival times to gastrojejunostomy. These results suggest the utility of stent therapy.
BACKGROUND: There are currently two treatment options for gastric outlet obstruction (GOO) due to gastric cancer, endoscopic stenting and surgical gastrojejunostomy. However, their therapeutic effects have not yet been established. Therefore, the present study was undertaken to examine these effects. METHODS: The Japanese Gastric Cancer Association invited its delegates to participate in a retrospective multicenter cohort study on patients with GOO due to gastric cancer who underwent stent therapy or gastrojejunostomy in 2015. RESULTS: We obtained data from 85 patients undergoing stent therapy and 94 undergoing gastrojejunostomy from 42 hospitals. Baseline data revealed that stent patients had lower food intake, poorer performance status, and worse prognostic indices than gastrojejunostomy patients. Postoperative food intake and survival times were worse in stent patients than in gastrojejunostomy patients. We performed propensity score matching to select pairs of patients with similar baseline characteristics in the two treatment groups. After matching, the frequency of postoperative complications was significantly less in stent patients (3%, 1/33) than in gastrojejunostomy patients (21%, 7/34; p = 0.03). A low residue or full diet was achieved by 97% of stent patients (32/33) and 97% of gastrojejunostomy patients (33/34) (p = 0.98). Median survival times were 7.8 months in stent patients and 4.0 months in gastrojejunostomy patients (p = 0.38). CONCLUSIONS: Propensity score matching demonstrated that endoscopic stent placement resulted in less postoperative morbidity than and a similar food intake and equivalent survival times to gastrojejunostomy. These results suggest the utility of stent therapy.