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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
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 Surgery (외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
김은혜(Kim, Eun Hye) ORCID logo https://orcid.org/0000-0001-6691-6837
김충배(Kim, Choong Bai)
김형일(Kim, Hyoung Il) ORCID logo https://orcid.org/0000-0002-6134-4523
노성훈(Noh, Sung Hoon) ORCID logo https://orcid.org/0000-0003-4386-6886
박준철(Park, Jun Chul) ORCID logo https://orcid.org/0000-0001-8018-0010
박찬혁(Park, Chan Hyuk)
신성관(Shin, Sung Kwan)
이상길(Lee, Sang Kil) ORCID logo https://orcid.org/0000-0002-0721-0364
이용찬(Lee, Yong Chan)
정재호(Cheong, Jae Ho) ORCID logo https://orcid.org/0000-0002-1703-1781
형우진(Hyung, Woo Jin) ORCID logo https://orcid.org/0000-0002-8593-9214
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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/139713
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