Ryohei Kawabata1,2, Kazumasa Fujitani3, Kentaro Sakamaki4, Masahiko Ando5, Yuichi Ito6, Yutaka Tanizawa7, Takanobu Yamada8, Motohiro Hirao9, Makoto Yamada10, Jun Hihara11, Yasuhiro Choda12, Yasuhiro Kodera13, Shin Teshima14, Hisashi Shinohara15, Masato Kondo16, Kazuhiro Yoshida17. 1. Department of Surgery, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai-city, , Osaka, 5918025, Japan. r-kawabata@umin.ac.jp. 2. Department of Surgery, Sakai City Medical Center, Sakai, Japan. r-kawabata@umin.ac.jp. 3. Department of Gastroenterological Surgery, Osaka Prefectural General Medical Center, Osaka, Japan. 4. Center for Data Science, Yokohama City University, Yokohama, Japan. 5. Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan. 6. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan. 7. Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Japan. 8. Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan. 9. Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 10. Department of Surgery, Gifu Municipal Hospital, Gifu, Japan. 11. Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan. 12. Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 13. Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan. 14. Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan. 15. Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan. 16. Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. 17. Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan.
Abstract
BACKGROUND: Our previous report showed that surgical palliation maintained quality of life (QOL), improved solid food intake, and had an acceptable surgical safety among patients with malignant bowel obstruction (MBO) caused by advanced gastric cancer. This study performed a survival analysis stratified by the patients' QOL to elucidate its impact on survival. METHODS: Patients who underwent resection or bypass of the small intestine/colon or ileostomy/colostomy for bowel obstruction caused by peritoneal dissemination of gastric cancer were included. Validated instruments (EuroQoL-5 Dimensions) were used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the Gastric Outlet Obstruction Scoring System (GOOSS). Univariate and multivariate survival analyses were performed using baseline characteristics and changes in QOL and GOOSS scores 2 weeks after surgery to determine prognostic factors. RESULTS: We enrolled 60 patients with a median survival time of 6.64 (95% CI 4.76-10.28) months. Patients who received postoperative chemotherapy and had lower baseline C-reactive protein (CRP) levels, higher baseline albumin levels, better baseline EuroQoL-5 Dimensions (EQ-5D) scores, and improved oral intake after palliative surgery exhibited significantly better survival. Multivariate analysis identified postoperative chemotherapy, lower baseline CRP levels, and improved oral intake as independent prognostic factors. CONCLUSIONS: The current study revealed that baseline QOL and postoperative QOL changes did not affect survival. Moreover, improved oral intake, lower baseline CRP levels, and postoperative chemotherapy were significant prognostic factors in patients who underwent palliative surgery for advanced gastric cancer with MBO.
BACKGROUND: Our previous report showed that surgical palliation maintained quality of life (QOL), improved solid food intake, and had an acceptable surgical safety among patients with malignant bowel obstruction (MBO) caused by advanced gastric cancer. This study performed a survival analysis stratified by the patients' QOL to elucidate its impact on survival. METHODS: Patients who underwent resection or bypass of the small intestine/colon or ileostomy/colostomy for bowel obstruction caused by peritoneal dissemination of gastric cancer were included. Validated instruments (EuroQoL-5 Dimensions) were used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the Gastric Outlet Obstruction Scoring System (GOOSS). Univariate and multivariate survival analyses were performed using baseline characteristics and changes in QOL and GOOSS scores 2 weeks after surgery to determine prognostic factors. RESULTS: We enrolled 60 patients with a median survival time of 6.64 (95% CI 4.76-10.28) months. Patients who received postoperative chemotherapy and had lower baseline C-reactive protein (CRP) levels, higher baseline albumin levels, better baseline EuroQoL-5 Dimensions (EQ-5D) scores, and improved oral intake after palliative surgery exhibited significantly better survival. Multivariate analysis identified postoperative chemotherapy, lower baseline CRP levels, and improved oral intake as independent prognostic factors. CONCLUSIONS: The current study revealed that baseline QOL and postoperative QOL changes did not affect survival. Moreover, improved oral intake, lower baseline CRP levels, and postoperative chemotherapy were significant prognostic factors in patients who underwent palliative surgery for advanced gastric cancer with MBO.