Gastric partitioning for the palliative treatment of patients with unresectable distal gastric cancer with gastric outlet obstruction

Abstract

Gastric cancer is still a very prevalent decease. Most patients show up in latter stages of the decease, frequently with unresectable distal tumor and gastric outlet obstruction, in need of palliative care, which main purpose is to provide the patient a better quality of life. Among the therapeutic alternatives, gastrojejunostomy comes as a traditional choice. However, because of the high complication rates of this procedure, the gastric partitioning surgery emerged as an option. Given the relevant results presented in comparative studies between these two techniques, our service started performing the gastric partitioning surgery for the treatment of gastric outlet obstruction in patients with unresectable distal gastric cancer. We analyzed retrospectively the results in terms of survival rate and quality of life. ECOG performance status of all patients were 0,1 or 2 and 53,9% presented GOOSS grades 0 or 1. Mean operation time was 169 minutes. In the postoperative period, there were 4 grade II Clavien-Dindo patients and 2 grade V (two deaths, meaning an operative mortality of 6,9%). Mean time to achieve GOOSS grade 2 was 5 days and, throughout the follow up, 96,15% of the patients achieved GOOSS grades 2 or 3. Mean survival rate was 213 days. Based on the obtained satisfactory results, the gastric portioning surgery is safe and effective, allowing the patients pertinent survival rate, oral food intake and quality of life.