M1995 The Usefulness of 18F-FDG PET/CT in the Evaluation of Recurrence After Curative Gastrectomy Due to Gastric Cancer

Abstract

Aim: to assess the efficacy of enteric prostheses for the treatment of gastroduodenal obstruction caused by non-surgical neoplasms, their effect on quality of life and survival, and to determine the factors related to efficacy and complications. Patients: enteric prosthesis insertion was indicated in 77 patients. In 6 of these patients insertion was attempted but not achieved, and thus they were not included in the analysis. The remaining 71 patients (31 male, 40 female) had a mean age of 73,10±12,4 years. The intention of of prosthesis insertion was: permanent, 63,4%; adjuvant to chemotherapy, 35,2%; and as a bridge to surgery, 1,4%. Mean Karnofsky index was 64,86±12,9. Methods: the prostheses used were: Wallflex (76,1%), Wallstent (16,9%), Ultraflex (7%) (all of them metallic, expandable, uncoated, produced by Boston Scientific). Insertion was monitored with combined endoscopic-radiologic control (50,7%) or endoscopic control only (49,3%). Efficacy of the prostheses was assessed with the GOOSS clinical index, and quality of life was assessed with EuroQol-5D questionnaire. Results: obstruction location was: gastric 25,4%, duodenal 53,5%, and surgical anastomosis 21,1%. The time required to insert the prosthesis was 20,49±8,6 min. The length of hospital admission was 3,3±3,4 days. Symptoms of gastroduodenal obstruction, measured by GOOSS, improved at least 2 points in 57 patients (p<0,001). Quality of life index (EuroQol-5D questionnaire) before and after prosthesis insertion was 10,17±2,07 and 10,04±2,65, respectively. Antral-gastric location of the lesion was significantly related to a worse prosthetic function (p<0,002). Patients in which radiologic control was not used did not have more complications or a longer prosthesis insertion time, but required more forced dilations of the stenotic lesion for prosthesis insertion (p<0,005). Mean survival was 116,52±119,0 days (range 9-552 days). Complications were: bleeding 7,0%, tumoral obstruction requiring surgery 2,8%, perforation 2,8%, and severe pain 2,8%. Tumoral growth with prosthesis obstruction requiring insertion of a second prosthesis occurred in 14.1% of cases. Conclusions: Enteric prostheses are useful for palliation of malignant gastroduodenal obstruction, but do not improve quality of life. Antral-gastric location of the stenotic lesion is related to worse results. Prosthesis insertion without radiologic control yields similar results regarding prosthesis function and complications, but requires a larger number of dilations for insertion.