Abstract
Purpose This study is aimed at evaluating the clinicopathological features and prognostic significance of gastric outlet obstruction (GOO) in patients with distal gastric cancer. Methods A retrospective review of 1564 individuals with distal gastric cancer from 2002 to 2010 was performed. In total, 157 patients had GOO. The clinicopathological features of the patients with GOO were compared with those of the patients without GOO. A Kaplan-Meier survival analysis and Cox proportional hazard model were used to assess the overall survival. Results The patients with distal gastric cancer with GOO generally presented more aggressive pathologic features, a poorer nutritional status, more duodenal infiltration, and peritoneal dissemination than those with cancer without GOO. In the univariate analysis, curability, GOO, age, prealbumin, albumin, hemoglobin (Hb), the tumor size, the macroscopic type, lymph node metastasis, and the depth of invasion had a statistically significant influence on prognosis. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. Conclusions Gastric cancer with GOO exhibits aggressive biological features and has poor outcomes. The multivariate analysis showed that curability, GOO, the tumor size, lymph node metastasis, and the depth of invasion were independent prognostic factors. The gastric outlet status should be considered in the selection of surgical treatment methods for patients with gastric cancer.
Highlights
Despite the steady decline in its incidence rate and mortality in recent years, more than 1.22 million incident cases of stomach cancer occurred worldwide in 2017, and nearly 865000 people died of stomach cancer
Compared to the patients without gastric outlet obstruction (GOO), those with GOO predominantly exhibited Borrmann type IV gastric carcinoma (12.7% vs. 9.2%), deeper tumor invasion (T4a, 43.9% vs. 37.2%; T4b, 40.1% vs. 28.1%; p ≤ 0:001), and more lymph node metastasis (N3a, 22.3% vs. 10.3%; N3b, 15.9% vs. 2.7%; p ≤ 0:001)
According to the multivariate analysis using a logistic regression model, the factors distinguishing the patients with GOO from those without GOO were lymph node metastasis, the depth of invasion, the prealbumin level, and the Borrmann type (Table 3)
Summary
Despite the steady decline in its incidence rate and mortality in recent years, more than 1.22 million incident cases of stomach cancer occurred worldwide in 2017, and nearly 865000 people died of stomach cancer. Surgical treatments include radical resection, palliative resection, and gastrojejunostomy, while nonoperative treatments include endoscopic stent therapy and combined chemotherapy. These approaches [2, 3] can alleviate complications, such as bleeding and obstruction, in patents with GOO. The effectiveness of surgery has been discussed [4], and it has been suggested that the morbidity and mortality of radical surgery can be acceptable in patients with GOO [5], while another study showed that the presence of GOO can predict increased postoperative morbidity following D2 gastrectomy for gastric cancer [6]. The aim of our study was to compare the differences in clinicopathological features between patients with and without GOO and explore the prognosis of the former to provide a basis for clinical treatment
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