BACKGROUND: The surgical outcome of gastric carcinomas with pyloric stenosis and their prognostic factors are sparsely documented. METHODS: A clinicopathologic study of gastric carcinoma with pyloric stenosis (PS group, n = 122) was done and findings were compared with the cases involving the antrum (A group, n = 695). Independent prognostic factors for survival of the patients with PS were determined by Cox's proportional hazard model. RESULTS: There were no differences in age and gender between the two groups. The PS group was characterized by an infiltrating growth pattern and undifferentiated adenocarcinoma. The incidence of serosal invasion, direct invasion into neighboring organs, peritoneal dissemination, lymph node metastasis, and liver metastasis of the PS group was higher than those of the A group (p < 0.01). The resection rate and 5-year survival of the PS group were 78% and 22%, respectively; these values were significantly lower than 98% and 58% of the A group (p < 0.01). Multivariate analyses showed that operative curability, resection of the stomach, liver metastasis, serosal invasion, and histologic type were the independent prognostic factors of the PS group. CONCLUSIONS: In cases of gastric carcinoma with pyloric stenosis, efforts should be made to do a curative operation, but for other patients with poor prognostic factors, intensive surgery and adjuvant therapy should be considered.
BACKGROUND: The surgical outcome of gastric carcinomas with pyloric stenosis and their prognostic factors are sparsely documented. METHODS: A clinicopathologic study of gastric carcinoma with pyloric stenosis (PS group, n = 122) was done and findings were compared with the cases involving the antrum (A group, n = 695). Independent prognostic factors for survival of the patients with PS were determined by Cox's proportional hazard model. RESULTS: There were no differences in age and gender between the two groups. The PS group was characterized by an infiltrating growth pattern and undifferentiated adenocarcinoma. The incidence of serosal invasion, direct invasion into neighboring organs, peritoneal dissemination, lymph node metastasis, and liver metastasis of the PS group was higher than those of the A group (p < 0.01). The resection rate and 5-year survival of the PS group were 78% and 22%, respectively; these values were significantly lower than 98% and 58% of the A group (p < 0.01). Multivariate analyses showed that operative curability, resection of the stomach, liver metastasis, serosal invasion, and histologic type were the independent prognostic factors of the PS group. CONCLUSIONS: In cases of gastric carcinoma with pyloric stenosis, efforts should be made to do a curative operation, but for other patients with poor prognostic factors, intensive surgery and adjuvant therapy should be considered.
Authors: Alisa N Blumenthaler; Naruhiko Ikoma; Mariela Blum; Prajnan Das; Bruce D Minsky; Paul F Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: J Surg Oncol Date: 2020-08-18 Impact factor: 3.454