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Impact of carcinomatosis and ascites status on long-term outcomes of palliative treatment for patients with gastric outlet obstruction caused by unresectable gastric cancer: stent placement versus palliative gastrojejunostomy

Authors
 Chan Hyuk Park  ;  Jun Chul Park  ;  Eun Hye Kim  ;  Hyunsoo Chung  ;  Ji Yeong An  ;  Hyoung-Il Kim  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Jae-Ho Cheong  ;  Woo Jin Hyung  ;  Yong Chan Lee  ;  Sung Hoon Noh  ;  Choong Bae Kim 
Citation
 GASTROINTESTINAL ENDOSCOPY, Vol.81(2) : 321-332, 2015 
Journal Title
GASTROINTESTINAL ENDOSCOPY
ISSN
 0016-5107 
Issue Date
2015
MeSH
Aged ; Ascites/etiology ; Ascites/pathology ; Ascites/therapy* ; Carcinoma/complications ; Carcinoma/pathology ; Carcinoma/therapy* ; Female ; Gastric Bypass* ; Gastric Outlet Obstruction/etiology ; Gastric Outlet Obstruction/pathology ; Gastric Outlet Obstruction/therapy* ; Humans ; Male ; Middle Aged ; Palliative Care* ; Retrospective Studies ; Stents* ; Stomach Neoplasms/complications ; Stomach Neoplasms/pathology ; Stomach Neoplasms/therapy* ; Treatment Outcome
Abstract
BACKGROUND: Self-expandable metal stent (SEMS) placement and palliative gastrojejunostomy (GJJ) are palliative treatment options for malignant gastric outlet obstruction. OBJECTIVE: To compare clinical outcomes of palliative treatments for gastric outlet obstruction caused by unresectable gastric cancer. DESIGN: Retrospective study. SETTING: University-affiliated tertiary-care hospital in the Republic of Korea. PATIENTS: Two hundred fifty-six patients with gastric outlet obstruction caused by unresectable gastric cancer. INTERVENTION: SEMS placement and palliative GJJ. MAIN OUTCOME MEASUREMENTS: Patency duration and overall survival duration. RESULTS: In total, 217 and 39 patients underwent SEMS placement and palliative GJJ, respectively, as an initial palliative treatment. Treatment modality affected reobstruction after clinical success (hazard ratio [HR] [95% confidence interval {CI}], 0.5 [0.3-0.8] of palliative GJJ). In addition, carcinomatosis with ascites was an independent associated factor of clinical success and reobstruction (HR [95% CI], 0.3 [0.1-0.7] and 1.4 [1.0-2.0], respectively). In a subgroup of patients with good performance who had neither carcinomatosis nor ascites, patency duration and overall survival duration did not differ between the 2 groups (P = .079 and P = .290, respectively). In patients with good performance who had carcinomatosis without ascites, patency duration was longer in the palliative GJJ group than in the SEMS placement group (P = .016). Overall survival, however, did not differ between the 2 groups (P = .062). In a subgroup of patients with good performance who had carcinomatosis with ascites, both patency duration and overall survival were longer in the palliative GJJ group than in the SEMS placement group (P = .007 and P = .012, respectively). LIMITATIONS: Nonrandomized, retrospective study. CONCLUSION: Long-term clinical outcomes of the palliative treatment modality for gastric outlet obstruction caused by unresectable gastric cancer were affected by carcinomatosis and ascites status.
Full Text
http://www.sciencedirect.com/science/article/pii/S0016510714018598
DOI
10.1016/j.gie.2014.06.024
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Eun Hye(김은혜) ORCID logo https://orcid.org/0000-0001-6691-6837
Kim, Choong Bai(김충배)
Kim, Hyoung Il(김형일) ORCID logo https://orcid.org/0000-0002-6134-4523
Noh, Sung Hoon(노성훈) ORCID logo https://orcid.org/0000-0003-4386-6886
Park, Jun Chul(박준철) ORCID logo https://orcid.org/0000-0001-8018-0010
Park, Chan Hyuk(박찬혁)
Shin, Sung Kwan(신성관) ORCID logo https://orcid.org/0000-0001-5466-1400
Lee, Sang Kil(이상길) ORCID logo https://orcid.org/0000-0002-0721-0364
Lee, Yong Chan(이용찬) ORCID logo https://orcid.org/0000-0001-8800-6906
Cheong, Jae Ho(정재호) ORCID logo https://orcid.org/0000-0002-1703-1781
Hyung, Woo Jin(형우진) ORCID logo https://orcid.org/0000-0002-8593-9214
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139713
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