Palliative Surgery or Metallic Stent Positioning for Advanced Gastric Cancer: Differences in QOL

Abstract

Background and Objectives: Twenty percent of the patients affected with stage IV antropyloric stomach cancer are hospitalized with a gastric outlet obstruction syndrome (GOOS) requiring its resolution to improve the quality of life (QoL). We present our preliminary short- and mid-term results regarding the influence of endoscopic placement of self-expandable metal stent (SEMS) or open stomach-partitioning gastrojejunostomy in QoL. Materials and Methods: In this prospective randomized longitudinal cohort trial, we randomly assigned 27 patients affected with stage IV antropyloric stomach cancer into two groups: Group 1 (13 patients) who underwent SEMS positioning and Group 2 (14 patients) in whom open stomach-partitioning gastrojejunostomy was performed. The Karnofsky performance scale and QoL assessment using the EQ-5D-5L™ questionnaire was administered before treatment and thereafter at 1, 3, and 6 months. Results: At 1-month, index values showed a statistically significant deterioration of the QoL in patients of Group 2 when compared to those of Group 1 (p = 0.004; CI: 0.04 to 0.21). No differences among the groups were recorded at 3-month; whereas, at 6-month, the index values showed a statistically significant deterioration of the QoL in patients of Group 1 (p = 0.009; CI: −0.25 to −0.043). Conclusions: Early QoL of patients affected with stage IV antropyloric cancer and symptoms of GOOS is significantly better in patients treated with SEMS positioning but at 6-month the QoL significantly decrease in this group of patients. We explained the reasons of this fluctuation with the higher risk of re-hospital admission in the SEMS group.

Impact of Systematic Holistic Nursing Combined with Narrative Nursing Intervention for Patients with Advanced Gastric Cancer on Complications and Negative Emotions

“…e middle-aged and elderly population are more susceptible to gastric cancer [4], and it has mostly developed to an the advanced stage at the time of diagnosis due to the insidiousness of early symptoms [5]. In addition to serious clinical stress responses, patients may also be subjected to obvious negative emotions and even depression and anxiety in severe cases [6,7], which further undermines the e cacy of surgery and chemotherapy. Moreover, systemic chemotherapy outcomes are dismal, with a median survival of 6-11 months.…”

Palliative procedures for malignant gastric outlet obstruction: a network meta-analysis

“…The difficulty in patient recruitment made it challenging to compare the four strategies and determine the optimal palliative treatment for GOO. Only three published RCTs compared gastrojejunostomy and endoscopic stenting, and only one RCT compared PGJ and endoscopic stenting [4,5,20,21]. Our gastrointestinal surgical teams advocated that clinicians should consider PGJ as a different type of treatment versus gastrojejunostomy.…”

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.…”