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Carcinomatosis matters: clinical outcomes and prognostic factors for clinical success of stent placement in malignant gastric outlet obstruction.

Authors
 Han Ho Jeon  ;  Chan Hyuk Park  ;  Jun Chul Park  ;  Choong Nam Shim  ;  Sunyong Kim  ;  Hyun Jik Lee  ;  Hyuk Lee  ;  Sung Kwan Shin  ;  Sang Kil Lee  ;  Yong Chan Lee 
Citation
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, Vol.28(3) : 988-995, 2014 
Journal Title
 SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 
ISSN
 0930-2794 
Issue Date
2014
MeSH
Adult ; Aged ; Aged, 80 and over ; Endoscopy, Gastrointestinal ; Female ; Fluoroscopy ; Follow-Up Studies ; Gastric Outlet Obstruction/diagnosis ; Gastric Outlet Obstruction/etiology ; Gastric Outlet Obstruction/surgery* ; Humans ; Male ; Middle Aged ; Neoplasms/complications* ; Neoplasms/diagnosis ; Palliative Care/methods* ; Prognosis ; Retrospective Studies ; Risk Factors ; Stents* ; Time Factors ; Treatment Outcome
Keywords
Ascites ; Carcinomatosis ; Gastric outlet obstruction ; Self-expandable metallic stent ; SEMS
Abstract
BACKGROUND: Although carcinomatosis is not a contraindication to stenting in selected patients with malignant gastric outlet obstruction (GOO), associate factors for clinical success rate of self-expandable metallic stent (SEMS) placement in GOO patients with carcinomatosis have not been fully characterized. METHODS: We analyzed a total 228 patients who were scheduled for SEMS placement for malignant GOO in tertiary-care academic medical center. All patients were treated with an uncovered or covered SEMS by using the over-the-wire placement procedure. We retrospectively evaluated clinical outcomes of SEMS placement. RESULTS: Technical success was achieved in all patients. Patients were categorized into two groups according to the presence of carcinomatosis. Clinical success rates of patients without carcinomatosis group and with carcinomatosis group were 93.9 % (92 of 98) and 80.8 % (105 of 130), respectively (P = 0.004). In subgroup analysis of patients with carcinomatosis, the clinical success rate was lower in patients with ascites (64.8 %) than in those without ascites (92.1 %, P < 0.001). Multivariate logistic regression model revealed that carcinomatosis without ascites did not decrease clinical success rate compared with absence of carcinomatosis; meanwhile, carcinomatosis with ascites showed lower clinical success rates compared with absence of carcinomatosis (adjusted odds ratio 0.163, 95 % confidence interval 0.058-0.461). In addition, poor performance status [Eastern Cooperative Oncology Group (ECOG) status ≥ 3, adjusted odds ratio 0.178, 95 % confidence interval 0.078-0.409] was also an independent poor predictive factor for clinical success of SEMS placement. CONCLUSIONS: In palliation for malignant GOO, the status of carcinomatosis with ascites and poor performance status (ECOG status ≥ 3) are significant predictive factors for poor clinical success of SEMS placement.
Full Text
http://link.springer.com/article/10.1007%2Fs00464-013-3268-x
DOI
10.1007/s00464-013-3268-x
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
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
Shim, Choong Nam(심충남)
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
Lee, Hyuk(이혁)
Lee, Hyun Jik(이현직)
Jeon, Han Ho(전한호)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/98286
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