The Significance of Prophylactic Gastrojejunostomy for Patients with Unresectable Stage IV Gastric Cancer

Kim, Hwan Soo; Kim, Chong Suk; Kim, Jong Han; Mok, Young Jae; Park, Sung Soo; Park, Seong Heum; Jang, You Jin; Kim, Seung Joo

Abstract

PURPOSE
The aim of this study was to evaluate the significance of palliative gastrojejunostomy for treating patients with unresectable stage IV gastric cancer, and as compared with laparotomy for treating patients with incurable gastric cancer.
MATERIALS AND METHODS
We retrospectively studied 167 patients who could not undergo resection without obstruction at Korea University Hospital from 1984 to 2007. They were classified into two groups, one that underwent palliative gastrojejnostomy (the bypass group, n=62) and one that underwent explo-laparotomy (the O&C group, n=105), and the clinical data and operative outcomes were compared according to the groups.
RESULTS
For the clinical characteristics, there were no differences of age, gender and liver metastasis between the bypass group and the explo-laparotomy group, but there was a significant different for the presence of peritoneal metastasis (P=0.001). There was no difference between two groups for the postoperative mortality and morbidity. For the postoperative outcomes, the duration of the hospital stay (29.25 vs 16.67) and the frequency of re-admission were not different, but the median overall survival (4.3 months vs. 3.4 months, respectively) was significantly different. By multivariate analysis, the presence of peritoneal metastasis was identified as the independent prognostic factor for incurable gastric cancer.
CONCLUSION
A prophylactic bypass procedure is not effective for improving the quality of life and prolonging the life expectancy of unresectable stage IV gastric cancer patients without obstruction.