Anastomotic recurrence of gastric cancer after total gastrectomy with esophagojejunostomy: palliation with covered expandable metallic stents

Abstract

Purpose: To assess the technical feasibility, safety, and clinical effectiveness of the placement of expandable metallic stents in patients with anastomotic recurrence of gastric cancer after total gastrectomy with esophagojejunostomy.

Materials and methods: The authors retrospectively analyzed data from 32 patients in whom metallic stents were placed for recurrent obstruction after total gastrectomy with esophagojejunostomy. Technical and clinical success and complications with related interventions were evaluated. Overall survival and stent patency rates were calculated according to the Kaplan-Meier method.

Results: Stent placement was technically successful in 30 of the 32 patients (94%). After stent placement, 29 patients (91%) experienced improvement of their symptoms. Fourteen complications occurred after stent placement, and these consisted of pain (n = 5, 16%), stent migration (n = 3, 9%), stent obstruction due to tumor overgrowth (n = 4, 13%), and abutment of the tortuous jejunal wall by the end of the stent (n = 2, 6%). In one of five patients with pain, the stent was removed 4 hours after placement because the pain could not be controlled with analgesics. The median survival and stent patency period were 87.0 and 140.0 days, respectively.

Conclusion: Placement of covered metallic stents in patients with anastomotic recurrence of gastric cancer after total gastrectomy with esophagojejunostomy is technically feasible, safe, and clinically effective.