Laparoscopic gastrojejunostomy versus endoscopic stenting combined with conversion therapy for gastric outlet obstruction

Abstract

Objective

There have been no studies comparing laparoscopic gastrojejunostomy (LGJ) and endoscopic metal stent placement (EMSP) combined with conversion therapy for gastric outlet obstruction (GOO) due to incurable advanced gastric cancer (GC). Therefore, the present study examined the short- and long-term outcomes and compared their therapeutic effects.

Methods

We retrospectively evaluated the clinical outcomes of 94 patients with GOO due to incurable advanced GC. Patients were assigned to the LGJ (n = 48) or EMSP (n = 46) groups. Multivariate analyses were conducted to identify the factors associated with overall survival. A propensity score-matched analysis was performed to avoid confounding bias.

Results

Compared to the EMSP group, patients in the LGJ group had fewer postoperative complications, better nutritional and inflammatory status, and a lower positive rate of tumor markers (p < .05). Conversion surgery was performed in 23 and 11 patients in the LGJ and EMSP groups, respectively. The median survival time (MST) in the LGJ group was 13.2 months, compared to 6.8 months for the EMSP group (p < .0001). Propensity score analyses confirmed this result. The MST of patients receiving conversion surgery was significantly better than that of patients without surgery in both the LGJ and EMSP groups (LGJ group: 38.3 months versus 7.6 months; EMSP group: 19.2 months versus 5.3 months, respectively, p < .0001). Multivariate analysis identified treatment selection and conversion surgery as independent prognostic factors for overall survival.

Conclusion

LGJ is an effective and feasible alternative to conversion therapy in terms of short- and long-term outcomes.

Keywords:

• Gastric cancer
• gastric outlet obstruction
• gastrojejunostomy
• stent
• conversion therapy

Acknowledgments

The authors wish to thank all colleagues and nurses who provided care to the patients in this study.

Disclosure statement

There is no conflict of interest from authors related this study.

Data availability statement

All data and materials generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.