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
ARTICLE HIGHLIGHTS
Research background

Gastric outlet obstruction (GOO) is a common complication during gastric cancer treatment. Different treatment modalities have been employed including endoscopic stent placement, surgical resection, and surgical bypass procedures. Surgical bypass may have better results when life expectancy is larger than 2 mo. It may be performed with a simple gastrojejunostomy (GJ) or with the addition of partial gastric partitioning (GP).

Research motivation

GJ has been traditionally performed as bypass procedure for GOO. However, delayed gastric emptying with impaired food ingestion may occur in up to 26% of cases. To overcome this setback, GP has been employed. The partitioning creates two separated gastric chambers that may improve gastric emptying, decrease tumor bleeding, and improve survival.

Research objectives

We compared the surgical results of GJ and GP for the treatment of GOO in patients with unresectable distal gastric cancer.

Research methods

We performed a retrospective analysis of 60 patients submitted to GJ and GP between 2009 and 2018. Clinicopathological characteristics and surgical outcomes were compared.

Research results

GP was performed in 30 patients and conventional GJ in the other 30 patients. Baseline clinicopathological characteristics were similar between groups, with the exception of worse performance status in GP patients. Surgical results related to postoperative complications and surgical mortality did not differ between groups. The median OS was 7 and 8.4 mo for 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). After multivariate analysis, acceptance of soft solids and low residue or full diet was the main prognostic factors for survival despite the surgical procedure performed (HR: 8.90, 95%CI: 3.38-23.43, P < 0.001).

Research conclusions

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

Research perspectives

After this initial experience using GP, a prospective trial was initiated and currently no patient has been submitted to any procedure for the treatment of GOO outside the protocol. The study is ongoing, recruiting patients, and is expected to be completed within the next year (ClinicalTrials.gov: NCT02064803).