Partial stomach-partitioning gastrojejunostomy and the success of this procedure in terms of palliation

Arrangoiz, Rodrigo; Papavasiliou, Pavlos; Singla, Smit; Siripurapu, Veeraiah; Li, Tianyu; Watson, James C.; Hoffman, John P.; Farma, Jeffrey M.

doi:10.1016/j.amjsurg.2012.11.015

Cited by 12 publications

(6 citation statements)

References 25 publications

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“…It also allows the endoscopic access to the tumor and the biliary tree in case of the necessity of biliary drainage. Still, gastric acid entry into the antrum is also maintained, decreasing the stimulation of gastrin and consequent risk of ulcer formation[18]. Regarding GE, the proximal gastric chamber created by partitioning has smaller dimensions in relation to the entire stomach, which is also dilated in many cases.…”

Section: Discussionmentioning

confidence: 99%

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Gastric partitioning for the treatment of malignant gastric outlet obstruction

Ramos

Barchi

Oliveira

et al. 2019

WJGO

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BACKGROUNDGastric outlet obstruction (GOO) is one of the main complications in stage IV gastric cancer patients. This condition is usually managed by gastrojejunostomy (GJ). However, gastric partitioning (GP) has been described as an alternative to overcoming possible drawbacks of GJ, such as delayed gastric emptying and tumor bleeding.AIMTo compare the outcomes of patients who underwent GP and GJ for malignant GOO.METHODSWe retrospectively analyzed 60 patients who underwent palliative gastric bypass for unresectable distal gastric cancer with GOO from 2009 to 2018. Baseline clinicopathological characteristics including age, nutritional status, body mass index, and performance status were evaluated. Obstructive symptoms were graded according to GOO score (GOOS). Surgical outcomes evaluated included duration of the procedure, surgical complications, mortality, and length of hospital stay. Acceptance of oral diet after the procedure, weight gain, and overall survival were the long-term outcomes evaluated.RESULTSGP was performed in 30 patients and conventional GJ in the other 30 patients. The mean follow-up was 9.2 mo. Forty-nine (81.6%) patients died during that period. All variables were similar between groups, with the exception of worse performance status in GP patients. The mean operative time was higher in the GP group (161.2 vs 85.2 min, P < 0.001). There were no differences in postoperative complications and surgical mortality between groups. The median overall survival was 7 and 8.4 mo for the GP and GJ groups, respectively (P = 0.610). The oral acceptance of soft solids (GOOS 2) and low residue or full diet (GOOS 3) were reached by 28 (93.3%) GP patients and 22 (75.9%) GJ patients (P = 0.080). Multivariate analysis demonstrated that GOOS 2 and GOOS 3 were the main prognostic factors for survival (hazard ratio: 8.90, 95% confidence interval: 3.38-23.43, P < 0.001).CONCLUSIONGP is a safe and effective procedure to treat GOO. Compared to GJ, it provides similar surgical outcomes with a trend to better solid diet acceptance by patients.

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Section: Discussionmentioning

confidence: 99%

“…Subsequently, the possibility of obstruction of the GJ by tumor growth is minimized. In addition, this technique has also been applied for tumors of the biliopancreatoduodenal confluence[9,18].…”

Section: Discussionmentioning

confidence: 99%

Gastric partitioning for the treatment of malignant gastric outlet obstruction

Ramos

Barchi

Oliveira

et al. 2019

WJGO

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“…Unlike Devine exclusion, their procedure allows posterior endoscopic assessment of the tumoral lesion. It can also be carried out laparoscopically, with good postoperative outcomes [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Modified Devine Exclusion for Unresectable Distal Gastric Cancer in Symptomatic Patients

Fernández-Moreno

Martí-Obiol

López

2017

Case Rep Gastroenterol

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Background: In patients with outlet obstruction syndrome and/or severe anemia secondary to unresectable gastric cancer (GC), partial stomach-partitioning gastrojejunostomy, or modified Devine exclusion, is a surgical alternative. Methods: A retrospective study was conducted on patients with unresectable distal GC treated with modified Devine exclusion as palliative surgery between February 2005 and December 2015. It consisted of a series of 10 patients with outlet obstruction syndrome and/or severe anemia. The outcomes of this technique were based on oral tolerance, blood transfusions, postoperative complications, and survival. Results: Early oral tolerance and a low rate of blood transfusions were observed postoperatively. There was no postoperative mortality and a very low complication rate without anastomotic leakage. Median survival was 9 months. Conclusions: Partial stomach-partitioning gastrojejunostomy is a safe procedure for unresectable GC which can improve the quality of life of these patients.

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“…En la revisión sistemática realizada por Zheng et al 18 desde 1996 a 2010, los casos de cáncer gástrico con estas características no superaban los 10 enfermos y así se muestra en la presente serie después de recoger los casos retrospectivamente de 12 años. Recordar que en el estudio solo se incluyen pacientes con cáncer gástrico, para ser más homogéneo, aunque esta técnica se puede aplicar también a tumores duodenales y pancreáticos 6,20,21 .…”

Section: Discussionunclassified