Multicentre observational study of quality of life after surgical palliation of malignant gastric outlet obstruction for gastric cancer

Abstract

BackgroundQuality of life (QoL) is a key component in decision‐making for surgical palliation, but QoL data in association with surgical palliation in advanced gastric cancer are scarce. The aim of this multicentre observational study was to examine the impact of surgical palliation on QoL in advanced gastric cancer.MethodsThe study included patients with gastric outlet obstruction caused by incurable advanced primary gastric cancer who had no oral intake or liquid intake only. Patients underwent palliative distal/total gastrectomy or bypass surgery at the physician's discretion. The primary endpoint was change in QoL assessed at baseline, 14 days, 1 month and 3 months following surgical palliation by means of the EuroQoL Five Dimensions (EQ‐5D™) questionnaire and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ‐STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.ResultsSome 104 patients (23 distal gastrectomy, 9 total gastrectomy, 70 gastrojejunostomy, 2 exploratory laparotomy) were enrolled from 35 institutions. The mean EQ‐5D™ utility index scores remained consistent, with a baseline score of 0·74 and the change from baseline within ± 0·05. Gastric‐specific symptoms showed statistically significant improvement from baseline. The majority of patients were able to eat solid food 2 weeks after surgery and tolerated it thereafter. The rate of overall morbidity of grade III or more according to the Clavien–Dindo classification was 9·6 per cent (10 patients) and the 30‐day postoperative mortality rate was 1·9 per cent (2 patients).ConclusionIn patients with gastric outlet obstruction caused by advanced gastric cancer, surgical palliation maintained QoL while improving solid food intake, with acceptable morbidity for at least the first 3 months after surgery. Registration number 000023494 (UMIN Clinical Trials Registry).

Survival analysis of a prospective multicenter observational study on surgical palliation among patients receiving treatment for malignant gastric outlet obstruction caused by incurable advanced gastric cancer

“…To detect a measured QOL difference of 0.3 standard deviation after palliation, a sample size of 100 was required [4]. For EQ-5D index scores and each QLQ-STO22 subscale, changes from baseline at each postoperative time point were used.…”

“…QOL was assessed using the EuroQoL Five Dimensions (EQ-5D; EuroQol Group, Rotterdam, The Netherlands) questionnaire [8] and the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire gastric cancer module (QLQ-STO22) [9,10] as described previously [4].…”

“…Assessment of quality of life (QOL) is considerably important for the treatment of patients with incurable disease. Our previous study reported that surgical palliation maintained QOL while improving solid food intake with acceptable surgical safety among patients with malignant gastric outlet obstruction (GOO) caused by advanced gastric cancer [4].…”

Relationship between initial management strategy and survival in patients with gastric outlet obstruction due to gastric cancer

“…Some of these patients underwent upfront palliative resection for relief of their symptoms despite their peritoneal disease. As regional therapies for peritoneal disease, particularly HIPEC, continue to improve, treatment options Fujitani et al16 evaluated changes in QOL measures after gastrectomy and surgical bypass for patients with metastatic or unresectable GC and GOO 16. Global QOL measures were not improved after the surgical interventions, but gastric-specific symptoms, including dysphagia, reflux, eating restrictions, pain, anxiety, and dry mouth, were improved up to 3 months after surgery 16.…”

“…As regional therapies for peritoneal disease, particularly HIPEC, continue to improve, treatment options Fujitani et al16 evaluated changes in QOL measures after gastrectomy and surgical bypass for patients with metastatic or unresectable GC and GOO 16. Global QOL measures were not improved after the surgical interventions, but gastric-specific symptoms, including dysphagia, reflux, eating restrictions, pain, anxiety, and dry mouth, were improved up to 3 months after surgery 16. Schmidt et al 17 evaluated QOL changes after palliative interventions for patients with GOO secondary to any type of cancer and, similarly, showed improvement in gastric-specific symptoms after both endoscopic stenting and surgical bypass.…”