Metallic Stent Placement in Patients with Recurrent Malignant Obstruction in the Surgically Altered Stomach

Abstract

The purpose of this study was to assess the technical feasibility and clinical effectiveness of expandable metallic stent placement in 196 patients with recurrent malignant obstruction in their surgically altered stomach. The 196 patients were treated using five different types of gastric surgery performed for gastric cancer: total gastrectomy (type 1) in 73 patients; distal gastrectomy with gastroduodenostomy (type 2) in 39 patients; distal gastrectomy with a Roux-en-Y gastrojejunostomy (type 3) in 21 patients; distal gastrectomy with a gastrojejunostomy (type 4) in 49 patients; and palliative gastrojejunostomy for unresectable gastric cancer (type 5) in 14 patients. The technical and clinical success rates, complications, dysphagia score, and influence of chemotherapy were evaluated and the complications compared between the two stent types. The overall survival and stent patency were calculated using the Kaplan-Meier method. Stent placement was technically successful in 192 of 196 patients (97.9%), with 184 of the 192 patients (95.8%) showing symptomatic improvement. The mean dysphagia score improved from 3.24±0.64 to 1.48±0.82 (p<0.001). The complication rate was 25%. The incidence of stent migration was significantly higher in fully covered stents and in patients who underwent chemotherapy (p<0.001 and p=0.005, respectively). Chemotherapy was significantly associated with an increase of survival (p<0.001). The median survival and stent patency were 131 and 90days, respectively. Placement of expandable metallic stents in patients with recurrent cancer after a surgically altered stomach is technically feasible and clinically effective. Chemotherapy was associated with increased stent migration and prolonged survival.