Abstract
194 Background: Inability of oral intake due to advanced gastric cancer with pyloric stenosis (AGCPS) should be avoided, because the key drug of chemotherapy for gastric cancer is S-1 in Japan. We have performed palliative gastrectomy (PG), gastrojejunostomy (GJ) or stent placement (SP) for unresectable AGCPS. We investigated therapeutic outcomes (gastric outlet obstruction scoring system: GOOSS, chemotherapy introduction rate: CIR and median survival time: MST) of each therapy retrospectively. Methods: Between April 1999 and April 2013, 42 patients with unresectable AGCPS were included in this study (PG/GJ/SP, 13/10/19). We compared therapeutic outcomes (GOOSS, CIR and MST) between the 3 groups. Results: The demographic characteristics of patients were similar across the three groups. We evaluated the Glasgow Prognostic Score (GPS) of all cases before treatment. GPS tended to be 1 in the PG group, 0 in the GJ group and 2 in the SP group. The proportion of GPS 2 in the SP group was higher than in PG or GJ group significantly (p=0.0056 for SP vs. PG, p=0.0191 for SP vs. GJ and p=0.007 for SP vs. Surgery). GOOSS scores of all patients were improved. GOOSS score 3 of PG/GJ/SP groups after treatment were 84.6 / 90 / 68.4% respectively. CIR, MST and post-operative complication rate of PG/GJ/SP groups were 53.8 / 90 / 42.1%, 222.5 / 435.5 / 74 days and 46.2 / 10 / 0%, respectively. The proportion of patients receiving chemotherapy was higher in the GJ group than in the PG group, and survival was longer in the GJ group than in the PG group. Post-operative complication rate was lower in GJ group than in PG group. Conclusions: GJ is well tolerated and offers improved survival compared with PG and SP in the patients with AGCPS. High CIR improved MST. Success of chemotherapy introduction might improve survival. Enabling oral intake is important for chemotherapy. However, it is very difficult to select a treatment method that suits the patient individually. GPS might be an important predictor in the selection of the treatment method for unresectable AGCPS.
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