Brief Article
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World J Gastroenterol. Jul 28, 2013; 19(28): 4559-4567
Published online Jul 28, 2013. doi: 10.3748/wjg.v19.i28.4559
Surgical management of patients with bowel obstructions secondary to gastric cancer
Wen-Guang Wu, Ping Dong, Xiang-Song Wu, Mao-Lan Li, Qi-Chen Ding, Lin Zhang, Jia-Hua Yang, Hao Weng, Qian Ding, Zhu-Jun Tan, Jian-Hua Lu, Jun Gu, Ying-Bin Liu
Wen-Guang Wu, Ping Dong, Xiang-Song Wu, Mao-Lan Li, Qi-Chen Ding, Lin Zhang, Jia-Hua Yang, Hao Weng, Qian Ding, Zhu-Jun Tan, Jian-Hua Lu, Jun Gu, Ying-Bin Liu, Laboratory of General Surgery, Department of General Surgery, Xinhua Hospital, Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China
Author contributions: Wu WG, Dong P and Liu YB designed research; Wu XS, Li ML and Ding QC performed research; Zhang L, Yang JH and Weng H contributed new reagents or analytic tools; Ding Q, Tan ZJ, Lu JH and Gu J analyzed data; Wu WG, Dong P and Liu YB wrote the paper; Wu WG and Dong P contributed equally to this work.
Correspondence to: Ying-Bin Liu, MD, PhD, Laboratory of General Surgery, Department of General Surgery, Xinhua Hospital, Affiliated to School of Medicine, Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai 200092, China. liuybphd@126.com
Telephone: +86-21-25076880 Fax: +86-21-25076880
Received: April 16, 2013
Revised: May 27, 2013
Accepted: June 1, 2013
Published online: July 28, 2013
Processing time: 103 Days and 18.2 Hours
Abstract

AIM: To assess whole-body fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the management of small bowel obstructions (SBOs) secondary to gastric cancer and its role in treatment strategies.

METHODS: The medical records of all of the patients who were admitted for an intestinal obstruction after curative resection for gastric cancer were retrospectively reviewed. PET/CT was performed before a clinical treatment strategy was established for each patient. The patients were divided into 2 groups: patients with no evidence of a tumor recurrence and patients with evidence of a tumor recurrence. Tumor recurrences included a local recurrence, peritoneal carcinomatosis or distant metastases. The primary endpoint was the 1-year survival rate, and other variables included patient demographics, the length of hospital stay, complications, and mortality.

RESULTS: The median time between a diagnosis of gastric cancer and the detection of a SBO was 1.4 years. Overall, 31 of 65 patients (47.7%) had evidence of a tumor recurrence on the PET/CT scan, which was the only factor that was associated with poor survival. Open and close surgery was the main type of surgical procedure reported for the patients with tumor recurrences. R0 resections were performed in 2 patients, including 1 who underwent combined adjacent organ resection. In the group with no evidence of a tumor recurrence on PET/CT, bowel resections were performed in 7 patients, adhesiolysis was performed in 7 patients, and a bypass was performed in 1 patient. The 1-year survival curves according to PET/CT evidence of a tumor recurrence vs no PET/CT evidence of a tumor recurrence were significantly different, and the 1-year survival rates were 8.8% vs 93.5%, respectively. There were no significant differences (P = 0.71) in the 1-year survival rates based on surgical vs nonsurgical management (0% with nonoperative treatment vs 20% after exploratory laparotomy).

CONCLUSION: 18F-FDG PET/CT can be used to identify the causes of bowel obstructions in patients with a history of gastric cancer, and this method is useful for planning the surgical management of these patients.

Keywords: Positron emission tomography/computed tomography; Small bowel obstructions; Gastric cancer; Clinical treatment strategy

Core tip: The management of patients who present with a small bowel obstruction (SBO) after treatment of primary carcinoma challenges the clinical judgement of even the most experienced surgeons when the feared cause is metastatic disease. It is difficult to predict whether the quality and/or the quantity of life in this group of patients will be improved by surgery. This study evaluated the clinical role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in identifying SBOs and its role in subsequent clinical treatment strategies. We found that 18F-FDG PET/CT is an appropriate method to identity the causes of bowel obstructions secondary to gastric cancer, and this method is useful for the surgical management of these patients.