Survival analysis of a prospective multicenter observational study on surgical palliation among patients with malignant bowel obstruction caused by peritoneal dissemination of gastric cancer

Kawabata, Ryohei; Fujitani, Kazumasa; Sakamaki, Kentaro; Ando, Masahiko; Ito, Y.; Tanizawa, Yutaka; Yamada, Takanobu; Hirao, Motohiro; Yamada, Makoto; Hihara, Jun; Ryoji,; Fukushima,; Choda, Yasuhiro; Kodera, Yasuhiro; Teshima, Shin‐ichi; Shinohara, Hisashi; Kondo, Masato; Yoshida, Kazuhiro

doi:10.1007/s10120-021-01251-z

Cited by 7 publications

(9 citation statements)

References 25 publications

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“…Factors known to be associated with diminished surgical benefit include high peritoneal disease burden, multifocal obstruction, ascites, multiple metastatic sites, high-grade histology, poor performance status, and indicators of poor nutrition, such as low serum albumin. 3,4,12,14,33,35,40,41,44,52,68,69 Small bowel obstruction is associated with a poor prognosis, as highlighted in Lodoli et al's study including 98 patients with peritoneal carcinomatosis. Amongst these patients, definitive surgery was not possible in 22% of cases, indicative of technical failure.…”

Section: Block 4 (Agreement: Round I -97% Round Ii -97%)mentioning

confidence: 99%

“…Of 1822 abstracts screened, 243 were included for full text review, and 25 studies reporting outcomes specific to patients with peritoneal metastases were included for data extraction and quality assessment. Of these, 12 studies focused on surgical palliation, [33][34][35][36][37][38][39][40][41][42][43][44] seven studies focused on percutaneous upper GI decompression (PGID), [7][8][9][45][46][47][48] and three studies each focused on upper GI and colorectal stenting. 17,18,23,[49][50][51] These studies are summarized in Tables 3-5 and elaborated upon in recommendations for blocks 2, 4 and 5.…”

Section: Rapid Reviewmentioning

confidence: 99%

“…The initial patient interview should include discussions on overall goals of care, present quality of life, performance status, nutritional status, prognosis, and treatment options available with multidisciplinary input. 41 Discussions about advance directives are crucial and should focus on the patient's desires regarding their surrogate decision maker, cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition, and hydration. Acknowledging the potential for fluctuations in goals of care throughout the course of treatment, the expert panel placed emphasis on iterative discussions, as highlighted in the top-most box in the pathway.…”

Section: Block 1 (Agreement: Round I -97% Round Ii -98%)mentioning

confidence: 99%

“…In our review encompassing 12 studies on surgical palliation for MGIO in patients with peritoneal carcinomatosis, eight studies addressed surgical correction, three focused on tumor debulking alongside surgical correction, and one addressed acute abdominal emergencies as detailed in Block 2 (Tables 3 and 5). [33][34][35][36][37][38][39][40][41][42][43][44] Technical success was defined as the ability to perform surgical correction, with rates ranging from 77.6% to 100%. 33,36,39 One study reported 100% technical success, however six patients with non-therapeutic laparotomy were excluded, suggesting an anticipated technical success rate below 100%.…”

Section: Surgerymentioning

confidence: 99%

“…[33][34][35][36][38][39][40]42 Hospital stays averaged between 9 and 24 days, 33,34,[36][37][38][39][40]42 while postoperative chemotherapy was initiated in 12.9% to 69.2% of cases. 33,35,[37][38][39]42,44 Reobstruction rates varied from 3.3% to 47.5%, [33][34][35]38,39,41 with postoperative complication rates between 17.3% and 50.0%. [33][34][35][36][38][39][40][41][42][43] Major complications, graded Clavien Dindo 3-4 equivalent, occurred in 0% to 24.8% of cases and were attributed mainly to intra-abdominal or cardiopulmonary sequelae such as collections requiring drainage, sepsis, bleeding, myocardial infarction, pulmonary embolism, and respiratory distress.…”

Section: Surgerymentioning

confidence: 99%

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Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Turaga

2024

Preprint

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Background: Malignant gastrointestinal obstruction (MGIO), a frequent complication of peritoneal surface malignancies (PSM), often portends a poor prognosis. The lack of high-quality evidence on optimal management strategies necessitated a national consensus to address this clinical problem. Methods: A clinical management pathway was designed through a Delphi consensus process with national experts in peritoneal disease. Two rounds of voting were conducted to assess agreement levels with pathway blocks. Supporting evidence regarding procedural interventions for MGIO underwent evaluation via a rapid literature review. Results: Of 111 participants responding in the first round, 90 (81%) responded in the second round. Over 90% consensus was achieved in 4/6 and 6/6 pathway blocks during rounds I and II, respectively. Encouraging a multidisciplinary approach, the pathway emphasized early palliative care assessments and iterative goals of care evaluation throughout treatment. Management was delineated based on obstruction acuity, and selection criteria for palliative-intent surgical interventions and stenting were elucidated. Studies demonstrated limited benefits for such interventions in patients with multifocal obstructions, poor performance status, and high-grade and/or high-burden PSMs. In these cases, a recommendation for supportive care or upper GI decompression tube placement was favored. The overall level of evidence was generally low-moderate in existing literature. Conclusion: Given limited evidence, the consensus-driven pathway provides crucial clinical guidance for practitioners dealing with MGIO in PSM patients. There is a need for high-quality prospective evidence in this domain.

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Section: Block 4 (Agreement: Round I -97% Round Ii -97%)mentioning

confidence: 99%

Section: Rapid Reviewmentioning

confidence: 99%

Section: Block 1 (Agreement: Round I -97% Round Ii -98%)mentioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

Section: Surgerymentioning

confidence: 99%

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Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Turaga

2024

Preprint

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Efficacy of palliative surgery for gastric cancer patients with peritoneal metastasis who still have residual peritoneal dissemination after chemotherapy

Shinkai

Imano

Kohda

et al. 2023

Langenbecks Arch Surg

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Gastric cancer patients with peritoneal metastasis (PM) are generally treated with systemic chemotherapy. When PM has disappeared because of chemotherapy, radical gastrectomy (so-called conversion surgery) is usually performed. We have previously reported the e cacy of conversion surgery, but there are no reports examining the e cacy of palliative gastrectomy for patients with residual PM after chemotherapy. The purpose of this study was to investigate the e cacy of palliative surgery for gastric cancer patients with PM who still have residual peritoneal dissemination after chemotherapy. MethodsTwenty-ve gastric cancer patients with PM con rmed by laparoscopy and who had received chemotherapy but who still had residual PM were included in this study. Among the 25 patients, palliative surgery was performed in 20 patients (PS group) and chemotherapy was continued in 5 patients (CTx group), and their therapeutic outcomes were compared. ResultsIn the PS group, total and distal gastrectomies were performed. Clavian-Dindo grade I postoperative complications occurred in two patients (10%). There were no treatment-related deaths. Postoperative chemotherapy was performed all cases. In the PS group, the median survival time (MST) reached 22.5 months, with 1-and 2-year overall survival (OS) rates of 95% and 45%, respectively, whereas in the CTx group, the MST was 15.8 months, and the 1-and 2-year OS rates were 60% and 0%, respectively. The PS group had signi cantly longer OS than the CTx group (P = 0.044). ConclusionsPalliative surgery is safe and may prolong survival in gastric cancer patients with residual PM after chemotherapy.

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Palliative surgery: state of the science and future directions

Lilley,

Farber,

Cooper

2024

British Journal of Surgery

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Palliative surgical procedures are operations that aim to alleviate symptoms in a patient with serious, life-limiting illness. They are common, particularly within the field of surgical oncology. However, few high-quality studies have attempted to measure the durability of improvements in symptoms and quality of life after palliative surgery. Furthermore, many of the studies that do exist are outdated and employ highly inconsistent definitions of palliative surgery. Consequently, the paucity of robust and reliable evidence on the benefits, risks, and trade-offs of palliative surgery hampers clinical decision-making for patients and their surgeons. The evidence for palliative surgery suggests that, with effective communication about goals of care and careful patient selection, palliative surgery can provide symptomatic relief and reduce healthcare burdens for certain seriously ill patients.

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Survival analysis of a prospective multicenter observational study on surgical palliation among patients with malignant bowel obstruction caused by peritoneal dissemination of gastric cancer

Cited by 7 publications

References 25 publications

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Consensus Guideline for the Management of Malignant Gastrointestinal Obstruction in Patients with Peritoneal Surface Malignancies

Efficacy of palliative surgery for gastric cancer patients with peritoneal metastasis who still have residual peritoneal dissemination after chemotherapy

Palliative surgery: state of the science and future directions

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