Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2019; 11(12): 1161-1171
Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1161
Gastric partitioning for the treatment of malignant gastric outlet obstruction
Marcus Fernando Kodama Pertille Ramos, Leandro Cardoso Barchi, Rodrigo Jose de Oliveira, Marina Alessandra Pereira, Donato Roberto Mucerino, Ulysses Ribeiro Jr, Bruno Zilberstein, Ivan Cecconello
Marcus Fernando Kodama Pertille Ramos, Leandro Cardoso Barchi, Rodrigo Jose de Oliveira, Marina Alessandra Pereira, Donato Roberto Mucerino, Ulysses Ribeiro Jr, Bruno Zilberstein, Ivan Cecconello, Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo 01249000, Brazil
Author contributions: Ramos MFKP, Barchi LC, Pereira MA designed the study, collected the data, conducted the statistical analysis, and drafted the manuscript; Oliveira RJ and Mucerino DR collected the data and reviewed the manuscript; Ribeiro Jr U, Zilberstein B, and Cecconello C critically analyzed the data and reviewed the manuscript.
Institutional review board statement: The study is part of the database project approved by the hospital ethics committee (NP771/15) and registered online (www.plataformabrasil.com; CAAE:43453515.6.0000.0065).
Informed consent statement: Due to the retrospective, non-interventional, and data analysis-based design of the study, informed consent was waived.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Marcus Fernando Kodama Pertille Ramos, FACS, MD, MSc, PhD, Attending Doctor, Department of Gastroenterology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo 251, São Paulo-SP 01249000, Brazil. marcus.kodama@hc.fm.usp.br
Telephone: +55-11-33932000 Fax: +55-11-33933994
Received: March 25, 2019
Peer-review started: March 26, 2019
First decision: July 31, 2019
Revised: September 3, 2019
Accepted: October 3, 2019
Article in press: October 3, 2019
Published online: December 15, 2019
Processing time: 260 Days and 12.7 Hours
Abstract
BACKGROUND

Gastric outlet obstruction (GOO) is one of the main complications in stage IV gastric cancer patients. This condition is usually managed by gastrojejunostomy (GJ). However, gastric partitioning (GP) has been described as an alternative to overcoming possible drawbacks of GJ, such as delayed gastric emptying and tumor bleeding.

AIM

To compare the outcomes of patients who underwent GP and GJ for malignant GOO.

METHODS

We retrospectively analyzed 60 patients who underwent palliative gastric bypass for unresectable distal gastric cancer with GOO from 2009 to 2018. Baseline clinicopathological characteristics including age, nutritional status, body mass index, and performance status were evaluated. Obstructive symptoms were graded according to GOO score (GOOS). Surgical outcomes evaluated included duration of the procedure, surgical complications, mortality, and length of hospital stay. Acceptance of oral diet after the procedure, weight gain, and overall survival were the long-term outcomes evaluated.

RESULTS

GP was performed in 30 patients and conventional GJ in the other 30 patients. The mean follow-up was 9.2 mo. Forty-nine (81.6%) patients died during that period. All variables were similar between groups, with the exception of worse performance status in GP patients. The mean operative time was higher in the GP group (161.2 vs 85.2 min, P < 0.001). There were no differences in postoperative complications and surgical mortality between groups. The median overall survival was 7 and 8.4 mo for the GP and GJ groups, respectively (P = 0.610). The oral acceptance of soft solids (GOOS 2) and low residue or full diet (GOOS 3) were reached by 28 (93.3%) GP patients and 22 (75.9%) GJ patients (P = 0.080). Multivariate analysis demonstrated that GOOS 2 and GOOS 3 were the main prognostic factors for survival (hazard ratio: 8.90, 95% confidence interval: 3.38-23.43, P < 0.001).

CONCLUSION

GP is a safe and effective procedure to treat GOO. Compared to GJ, it provides similar surgical outcomes with a trend to better solid diet acceptance by patients.

Keywords: Stomach neoplasms; Gastric outlet obstruction; Palliative surgery; Gastrojejunostomy; Gastric cancer

Core tip: Gastric partitioning associated with gastrojejunostomy has been employed for the treatment of malignant obstruction. The partitioning creates two separated gastric chambers that may improve gastric emptying, decrease tumor bleeding, and improve survival. We analyzed retrospective data from our center and found that partitioning was as safe and effective as traditional gastrojejunostomy. Postoperative complications and survival were similar between the groups. Acceptance of soft and full diet after the procedure was the most important prognostic variable and was more common after gastric partitioning. A prospective randomized trial is ongoing to further analyze this issue.