Influence of peritoneal carcinomatosis on perioperative outcome in palliative gastric bypass for malignant gastric outlet obstruction - a retrospective cohort study

Abstract

Background: Malignant gastric outlet obstruction (GOO) is commonly associated with the presence of peritoneal carcinomatosis (PC) and preferably treated by surgical gastrojejunostomy (GJJ) in patients with good performance. Here, we aim to investigate the role of PC as a risk factor for perioperative morbidity and mortality in patients with GOO undergoing GJJ. Methods: Perioperative data of 72 patients with malignant GOO who underwent palliative GJJ at our institution between 2010 and 2019 were collected within an institutional database. To compare perioperative outcomes of patients with and without PC, extensive group analyses were carried out. Results: A set of 39 (54.2%) patients was histologically diagnosed with concomitant PC while the remaining 33 (45.8%) patients showed no clinical signs of PC. In-house mortality due to surgical complications was significantly higher in patients with PC (9/39, 23.1%) than in patients without PC (2/33, 6.1%, p = .046). Considerable differences were observed in terms of surgical complications such as anastomotic leakage rates (2.8% vs. 0%, p = .187), delayed gastric emptying (33.3% vs. 15.2%, p = .076), paralytic ileus (23.1% vs. 9.1%, p = .113), and pneumonia (17.9% vs. 12.1%, p = .493) without reaching the level of statistical significance. Conclusions: PC is an important predictor of perioperative morbidity and mortality patients undergoing GJJ for malignant GOO.

Gastric cancer with positive peritoneal cytology: survival benefit after induction chemotherapy and conversion to negative peritoneal cytology

“…In the current literature, we can find some other important predictors that should be considered in the therapeutic decision-making. For example, peritoneal carcinomatosis itself appears to be a major driver of complications and dismal outcome for surgical gastrojejunostomy and should call for caution in the surgical strategy [ 39 ]. Moreover, an interesting study by Chen including 518 patients highlights the importance of the body mass index as another predicting factor for patients who have gastric cancer with peritoneal dissemination, especially in those who received palliative chemotherapy [ 40 ].…”

Endoscopic ultrasound-guided gastroenterostomy versus surgical gastrojejunostomy for the palliation of gastric outlet obstruction in patients with peritoneal carcinomatosis

“…The presence of peritoneal carcinomatosis may negatively impact outcomes in individuals who undergo SGJ. A recent study revealed that peritoneal carcinomatosis is an independent risk factor for worse clinical outcomes following SGJ 8 . The authors reported 72 patients with malignant GOO who were initially referred for curative resection but instead received a palliative SGJ when they were found intraoperatively to have unresectable disease.…”

“…Our study is consistent with the prior literature, showing a substantial AE rate of 41 % for SGJ. This higher complication rate seen among patients with peritoneal carcinomatosis could be explained by possible distal subclinical obstruction at the time of surgery that could cause elevation of the intraluminal pressure and subsequent anastomotic leakage 8 24 . Additionally, malnutrition and tumor cachexia are associated with higher tumor burden as both are major risk factors for poor wound healing and increased surgical complications 22 25 .…”

“…Studies evaluating the safety and efficacy of EUS-GE have included relatively few subjects with the presence of peritoneal carcinomatosis, ranging from 33 %-46.7 % of all included participants, with none focusing on this patient population [17][18][19]. Furthermore, the presence of peritoneal carcinomatosis has been demonstrated to be a major risk factor for adverse events following SGJ and has been suggested to be a contraindication for EUS-GE [8]. One prior multicenter study evaluated EUS-GE vs. SGJ and showed comparable outcomes with fewer adverse events for EUS-GE [7]; however, data comparing these modalities in patients with peritoneal carcinomatosis are lacking.…”

Current management of malignant bowel obstructions: a survey of acute care surgeons and surgical oncologists

“…Evidence of peritoneal carcinomatosis is also an independent risk factor for surgical complications. 15 We identified that surgeons were also less likely to operate on patients with multiple sites of obstruction, recurrent MSBO, and shorter disease-free intervals from their initial surgical treatment. In future studies of patients with MSBO, these factors should be assessed for their effect on clinical outcomes.…”