Abstract
BackgroundIt is still unclear whether the peritoneal carcinomatosis had a negative effect on the clinical outcomes of patients who underwent self-expandable metallic stent (SEMS) placement for malignant gastric outlet obstruction (GOO). Although carcinomatosis may be associated with the development of multifocal gastrointestinal (GI) tract obstruction or decreased bowel movement, previous studies investigated the occurrence of stent failure only and thus had limitation in evaluating clinical outcomes of patients with carcinomatosis.MethodsBetween 2009 and 2013, 155 patients (88 patients without carcinomatosis and 67 patients with carcinomatosis) underwent endoscopic SEMS placement for malignant GOO. Factors affecting clinical success and obstructive symptom-free survival (time period between SEMS placement and the recurrence of obstructive symptoms due to multifocal GI tract obstruction or decreased bowel movement as well as stent failure) were assessed.ResultsPatients with carcinomatosis showed higher Eastern Cooperative Oncology Group (ECOG) scale than those without carcinomatosis. Clinical success rates were 88.1% in patients with carcinomatosis and 97.7% in patients without carcinomatosis. In multivariate analysis, only ECOG scale was identified as an independent predictor of clinical success. During follow-up period, patients with carcinomatosis showed significantly shorter obstructive symptom-free survival than those without carcinomatosis. In multivariate analysis, the presence of carcinomatosis, chemotherapy or radiation therapy after SEMS placement, and obstruction site were identified as independent predictors of obstructive symptom-free survival. For patient without carcinomatosis, stent failure accounted for the recurrence of obstructive symptoms in 84.6% of cases. For patients with carcinomatosis, multifocal GI tract obstruction or decreased bowel movement accounted for 37.9% of cases with obstructive symptom recurrence and stent failure accounted for 44.8% of cases.ConclusionsCarcinomatosis predicts unfavorable long-term clinical outcomes in patients undergoing SEMS placement for malignant GOO. This is mainly due to the development of multifocal GI tract obstructions or decreased bowel movement as well as stent failure.
Highlights
Malignant gastric outlet obstruction (GOO) is defined as the inability of the stomach to empty due to mechanical obstruction by any malignancies at the level of either the distal stomach or the duodenum
Carcinomatosis predicts unfavorable long-term clinical outcomes in patients undergoing self-expandable metallic stent (SEMS) placement for malignant GOO. This is mainly due to the development of multifocal GI tract obstructions or decreased bowel movement as well as stent failure
We investigated the impact of carcinomatosis on the clinical success and long-term outcomes of patients undergoing SEMS placement for malignant GOO
Summary
Malignant gastric outlet obstruction (GOO) is defined as the inability of the stomach to empty due to mechanical obstruction by any malignancies at the level of either the distal stomach or the duodenum. Peritoneal carcinomatosis is considered a relative contraindication to SEMS placement for malignant GOO given the theoretical risk of multifocal GI tract obstructions and decreased bowel movement [1, 2, 5]. In two Korean studies [7, 8], patients with carcinomatosis showed significantly lower clinical success rates than those without carcinomatosis It is still unclear whether the peritoneal carcinomatosis had a negative effect on the clinical outcomes of patients who underwent self-expandable metallic stent (SEMS) placement for malignant gastric outlet obstruction (GOO). Carcinomatosis may be associated with the development of multifocal gastrointestinal (GI) tract obstruction or decreased bowel movement, previous studies investigated the occurrence of stent failure only and had limitation in evaluating clinical outcomes of patients with carcinomatosis
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