Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum

Abstract

Background: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum.Methods: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected data included: age, gender, performance status (Karnofsky's score), body mass index, histopathology, clinical stage (TNM classification), technical and clinical success of the procedure, time to oral intake, in-hospital stay, reintervention rate, and complications related to the treatment and survival.Results: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky's score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001) and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005). We did not find statistically significant differences with regards to long-term survival.Conclusions: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter inhospital stay and lower rate of complications.Key words: Self-expanding metal stents. Antrectomy. Gastric cancer. INTRODUCTIONGastric cancer patients present with an unresectable tumor in up to 40% of cases (1,2). Gastric outlet obstruction (GOO) is a frequent complications and presents as nausea, vomiting, dehydration and eventually malnutrition. Most patients at this stage have a short life expectancy if left without treatment (3-5). Open gastrojejunostomy (OGJ) has been considered the preferred treatment for relieving malignant GOO with good results and adequate symptom relief in most cases. Early major complications of OGJ can be seen in 6% of patients and late complications in up to 17%, and are similar to those of self-expanding metal stents (SEMS) (6% for early and 18% for late complications) (6). However, OGJ has a higher overall mortality when compared to SEMS (29 vs. 17%; p < 0.001) (7).Patients with OGJ have delayed gastric emptying, which can decrease oral intake for up to 8 days (8). While laparoscopic gastrojejunostomy is less invasive, adequate gastrointestinal function can also be delayed for a similar period, with this approach (9). Gastric stents are less invasive than surge...

Palliative distal gastrectomy offers no survival benefit over gastrojejunostomy for gastric cancer with outlet obstruction: retrospective analysis of an 11-year experience

“…Theoretically, endoscopic stenting is the most minimally invasive approach for outlet obstruction currently available. Self-expanding stents reportedly achieve earlier improvement of oral intake and a lower morbidity rate than surgical interventions [ 21 – 24 ]. Recent reports have recommended endoscopic stenting for patients with life expectancies shorter than 2 months, while GJ is preferable for those with good PS and/or longer estimated survival according to their patency duration [ 23 – 25 ].…”

Palliative Therapy for Gastric Outlet Obstruction Caused by Unresectable Gastric Cancer

“…Gastrojejunostomy (GJJ) is the standard palliative treatment for GOO and adequately relieves obstructive symptoms in most cases. [ 7 8 9 ] However, the incidence of delayed gastric emptying after conventional GJJ is significant (20%–59%),[ 10 11 12 13 ] and the postoperative mortality rate reportedly varies from 18% to 24%. [ 2 13 14 ] Endoscopic stenting (ES) is increasingly being performed for malignant GOO.…”

Korean Practice Guidelines for Gastric Cancer 2022: An Evidence-based, Multidisciplinary Approach

“…In this clinical guideline, we compared the outcomes of ES with GJ by conducting a meta-analysis. Our literature search identified 1,637 articles, and a total of 15 studies were finally selected through the literature selection process [ 186 408 409 410 411 412 413 414 415 416 417 418 419 420 ]. These studies were included in the final table of evidence, i.e., 12 observational studies in addition to 3 RCTs.…”