Ramos MFKP, Pereira MA, Dias AR, Sakamoto E, Ribeiro Jr U, Zilberstein B, Nahas SC. Jejunostomy in the palliative treatment of gastric cancer: A clinical prognostic score . World J Clin Oncol 2021; 12(10): 935-946 [PMID: 34733615 DOI: 10.5306/wjco.v12.i10.935]
Corresponding Author of This Article
Marcus Fernando Kodama Pertille Ramos, MD, PhD, Surgeon, Surgical Oncologist, Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo 01246000, Brazil. marcus.kodama@hc.fm.usp.br
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
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/
World J Clin Oncol. Oct 24, 2021; 12(10): 935-946 Published online Oct 24, 2021. doi: 10.5306/wjco.v12.i10.935
Jejunostomy in the palliative treatment of gastric cancer: A clinical prognostic score
Marcus Fernando Kodama Pertille Ramos, Marina Alessandra Pereira, Andre Roncon Dias, Erica Sakamoto, Ulysses Ribeiro Jr, Bruno Zilberstein, Sergio Carlos Nahas
Marcus Fernando Kodama Pertille Ramos, Marina Alessandra Pereira, Andre Roncon Dias, Erica Sakamoto, Ulysses Ribeiro Jr, Bruno Zilberstein, Sergio Carlos Nahas, Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
Author contributions: Ramos MFKP and Pereira MA performed the study design, data retrieval, statistical analysis, critical analysis, the draft of the manuscript; Dias AR and Sakamoto E performed the data retrieval and manuscript review; Ribeiro Jr U, Zilberstein B and Nahas SC performed the critical analysis and manuscript review.
Institutional review board statement: The study was approved by the hospital ethics committee and registered online (https://plataformabrasil.saude.gov.br; CAAE: 31626220.8.0000.0068).
Informed consent statement: Informed consent was waived by the local Ethics Committee because of the retrospective nature of the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest that might be relevant to the contents of this manuscript.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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, MD, PhD, Surgeon, Surgical Oncologist, Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av Dr Arnaldo 251, São Paulo 01246000, Brazil. marcus.kodama@hc.fm.usp.br
Received: March 31, 2021 Peer-review started: March 31, 2021 First decision: June 28, 2021 Revised: July 3, 2021 Accepted: September 14, 2021 Article in press: September 14, 2021 Published online: October 24, 2021 Processing time: 205 Days and 7.9 Hours
ARTICLE HIGHLIGHTS
Research background
Palliative gastrectomy is the initial treatment option for locally advanced gastric cancer (GC) with gastric outlet obstruction whenever it is feasible. Unfortunately, in some cases, nasoenteric tube or jejunostomy becomes the therapeutic alternative to allow maintenance of nutritional enteral support.
Research motivation
The limited survival of these patients raises doubts about who benefits from jejunostomy.
Research objectives
This study aimed to create a prognostic score for 90-d mortality for stage IV GC patients who underwent jejunostomy based on the clinical variables related to survival.
Research methods
We conducted a retrospective analysis of 80 stage IV patients who underwent jejunostomy for obstructive GC. To create a scoring system, patients were randomized into two groups (1:1) by computer using statistical software. The score was developed with half of the patients and further evaluated in a validation cohort with the remaining patients. The score was developed with 90-d mortality as the main outcome.
Research results
We provided a simple and feasible score system with 11 variables easily available in the clinical assessment of patients. The score demonstrated an accuracy of 75.6% in the validation cohort and was associated with the mortality rates in patients who underwent jejunostomy.
Research conclusions
The scoring system developed with variables related to patient’s performance status and medical condition was able to distinguish patients submitted to jejunostomy with a high risk of 90 d mortality.
Research perspectives
The results of our series may contribute to identifying stage IV GC with unresectable tumors who can obtain better results with the jejunostomy. In addition, the score may contribute to the selection of patients who were able to receive chemotherapy, and thereby improving their survival.
