Laparoscopic gastrojejunostomy versus duodenal stenting in unresectable gastric cancer with gastric outlet obstruction

Abstract

PurposeTo compare the outcome between laparoscopic gastrojejunostomy (LapGJ) and duodenal stenting (DS) in terms of oral intake, nutritional status, patency duration, effect on chemotherapy and survival.MethodsMedical records of 115 patients, who had LapGJ or duodenal stent placement between July 2005 and September 2015 in Seoul National University Bundang Hospital, have been reviewed retrospectively. Oral intake was measured with Gastric Outlet Obstruction Scoring System. Serum albumin and body weight was measured as indicators of nutritional status. The duration of patency was measured until the date of reintervention. Chemotherapy effect was calculated after the procedures. Survival period and oral intake was analyzed by propensity score matching age, sex, T-stage, comorbidities, and chemotherapy status.ResultsForty-three LapGJ patients and 58 DS patients were enrolled. Improvement in oral intake was shown in LapGJ group versus DS group (88% vs. 59%, P = 0.011). Serum albumin showed slight but significant increase after LapGJ (+0.75 mg/dL vs. −0.15 mg/dL, P = 0.002); however, there was no difference in their body weight (+5.1 kg vs. −1.0 kg, P = 0.670). Patients tolerated chemotherapy longer without dosage reduction after LapGJ (243 days vs. 74 days, P = 0.006) and maintained the entire chemotherapy regimen after the procedure longer in LapGJ group (247 days vs. 137 days, P = 0.042). LapGJ showed significantly longer survival than DS (220 vs. 114 days, P = 0.004).ConclusionDS can provide faster symptom relief but LapGJ can provide improved oral intake, better compliance to chemotherapy, and longer survival. Therefore, LapGJ should be the first choice in gastric outlet obstruction patients for long-term and better quality of life.

Big End Double-Layer Stents for the Treatment of Gastric Outlet Obstruction Caused by Stomach Cancer

“…The mean cost of treatment with the big end double-layer uncovered SEMS was $2,945, which was higher than that with the individualized or funnel SEMS in China [10, 19]. Although the cost of the big end double-layer uncovered SEMS was higher, it was cost-efficient for the long-term run due to its lower reintervention rate (4.3%) and longer survival time (212.5 days) compared with monolayer SEMS [24–27]. Thus, the big end double-layer uncovered SEMS did not increase the total treatment cost for patients with GOO.…”

Staged laparoscopic management of locally advanced gastric cancer with outlet obstruction

“…[17][18][19] However, this procedure can lead to a high rate of re-interventions because of tumor overgrowth or ingrowth, stent migration, or angulation. 6,17 Gastrojejunostomy has been reported to be superior to stents in terms of patients' long-term survival, 20 leading the authors to conclude that gastrojejunostomy should be the primary treatment for patients with good health status and a reasonable life expectancy. The rationale for the staged procedure rather than the stent is: first, initial laparoscopic exploration offers a more precise evaluation of tumor staging than imaging does; second, initial gastrojejunostomy constitutes a part of the reconstruction procedure, which substantially simplifies and reduces the operative time of the secondary intervention; and third, radical gastrectomy is better than palliative gastroenterostomy.…”

“…4 Laparoscopic GJ is effective and safe. [5][6][7] Currently, intensified chemotherapy, and new targeted therapies improve the tumor response rate and might pave the way to curative distal gastrectomy for initially unresectable tumors. 8,9 In the present study, we report our experience of curative distal gastrectomy after laparoscopic GJ and fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy to examine the feasibility and safety of this modified strategy for initially deemed unresectable, locally AGC with outlet obstruction.…”

Gastric outlet obstruction: A red flag, potentially manageable

“…Postsurgical complications were more common in the laparoscopic gastrojejunostomy group (16%) than in the duodenal stenting group (0%). 57 In most of the studies comparing endoscopic stenting with surgery, the surgery was open gastrojejunostomy; there are limited data directly comparing stenting with laparoscopic gastrojejunostomy. 55 Endoscopic stenting is estimated to be signifi cantly less costly than surgery, with a median cost of $12,000 less than gastrojejunostomy.…”