High prevalence of peritoneal metastasis in gastric cancer presenting gastric outlet obstruction: A new candidate for consecutive diagnostic staging laparoscopy and laparoscopic gastrojejunostomy

Abstract

IntroductionGastric cancer presenting gastric outlet obstruction (GC-GOO) is associated with two problems to be considered in its treatment: peritoneal metastasis and an inability to intake food. Because peritoneal metastasis is difficult to identify in standard examinations, laparoscopic gastrojejunostomy (LGJ), which consecutively follows diagnostic staging laparoscopy (DSL), may be a minimally invasive solution to these diagnostic and therapeutic problems. However, whether GC-GOO is a new candidate for DSL has been not evaluated. Materials and methodsGC-GOO patients who were surgically treated at our department between 2005 and 2014 were recruited. Patient backgrounds, preoperative and surgical findings for distant metastasis, and surgical curability were retrospectively evaluated. To predict peritoneal metastasis, the sensitivity, specificity, and positive and negative predictive values of preoperative factors were calculated. The survival outcomes were also evaluated according to surgical curability and non-curative factors. ResultsA total of 237 patients with GC-GOO were included in this study. Among them, 167 patients had no distant metastasis identified preoperatively. Seventy-one of 167 patients underwent curative surgery while 75 (44.9%) had peritoneal metastasis including positive lavage cytology. Ascites and large type 3 or type 4 tumors indicated high specificity (86.9% and 76.1%, respectively) and the involvement of gastric angle presented high sensitivity (90.7%) for peritoneal metastasis. The overall survival of patients with incurable surgery was worse than that of patients with curative surgery, regardless of their incurable factors. ConclusionGC-GOO is a new candidate for DSL. DSL followed by LGJ may be proposed, utilizing preoperative predictive factors for peritoneal metastasis.