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Randomized Controlled Trial
. 2024 Dec 30;9(1):zrae152.
doi: 10.1093/bjsopen/zrae152.

Gastric partitioning versus gastrojejunostomy for gastric outlet obstruction due to unresectable gastric cancer: randomized clinical trial

Marcus Fernando Kodama Pertille Ramos  1 , Marina Alessandra Pereira  1 , André Roncon Dias  1 , Osmar Kenji Yagi  1 , Bruno Zilberstein  1 , Ulysses Ribeiro-Junior  1
Affiliations
Randomized Controlled Trial

Gastric partitioning versus gastrojejunostomy for gastric outlet obstruction due to unresectable gastric cancer: randomized clinical trial

Marcus Fernando Kodama Pertille Ramos et al. BJS Open. .

Abstract

Background: Gastric outlet obstruction due to unresectable tumours is usually managed with a gastrojejunostomy. Unfortunately, the unsatisfactory outcomes of this procedure have led to the search for alternatives, including gastric partitioning.

Methods: Monocentric, randomized, parallel, open-label trial that included patients with obstructive, unresectable distal gastric tumours. The objective was to compare gastric partitioning to gastrojejunostomy, considering the gastric outlet obstruction scoring system scale as the main outcome. Randomization was performed using computer-generated software available online and after the application of the informed consent term, the allocation group was revealed to the surgeon before the surgical procedure.

Results: Over 7 years, 90 patients were initially randomized. After applying the inclusion and exclusion criteria, 25 patients were included in the gastrojejunostomy group and 27 in the partitioning group. Both groups were similar regarding initial clinical characteristics including sex, age, weight, clinical performance, and the acceptance of oral diet. Surgery duration, length of hospital stay, postoperative complications, and 30- and 90-day mortality rates were similar between groups. Acceptance of normal diet was more frequently reached by patients in the partitioning group (96% versus 72%; P = 0.022). During outpatient follow-up, maintenance of oral intake and weight was similar between groups. Patients in the partitioning group received more frequent red blood cell transfusions (81% versus 52%; P = 0.024). There was no difference regarding the administration of palliative chemotherapy lines and survival. In the multivariable analysis, the inability to eat a full diet (P = 0.035) and the absence of palliative chemotherapy after the procedure (P = 0.001) were associated with worse survival.

Conclusions: Gastric partitioning provided a better return of the ability to accept food orally. There was no difference regarding postoperative complications and long-term survival.

Trial registration: NCT02065803, clinicaltrials.gov.

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Figures

Fig. 1
Fig. 1
Gastric partitioning surgical scheme a Positioning of the stapler proximal to the gastric tumour. b Final aspect after the partial gastric transection with the gastrojejunostomy on the proximal gastric chamber.
Fig. 2
Fig. 2
Flowchart of the study
Fig. 3
Fig. 3
Overall survival stratified by gastric partitioning versus gastrojejunostomy only groups
See this image and copyright information in PMC

References

    1. Hartgrink HH, Putter H, Klein Kranenbarg E, Bonenkamp JJ, van de Velde CJ. Value of palliative resection in gastric cancer. Br J Surg 2002;11:1438–1443 - PubMed
    1. Jeurnink SM, Steyerberg EW, Vleggaar FP, van Eijck CHJ, van Hooft JE, Schwartz MP et al. Predictors of survival in patients with malignant gastric outlet obstruction: a patient-oriented decision approach for palliative treatment. Dig Liver Dis 2011;7:548–552 - PubMed
    1. van Hooft JE, Dijkgraaf MG, Timmer R, Siersema PD, Fockens P. Independent predictors of survival in patients with incurable malignant gastric outlet obstruction: a multicenter prospective observational study. Scand J Gastroenterol 2010;45:1217–1222 - PubMed
    1. Ramos MFKP, Pereira MA, Dias AR, Castria TB, Sakamoto E, Ribeiro-Jr U et al. Surgical treatment in clinical stage IV gastric cancer: a comparison of different procedures and survival outcomes. Arq Bras Cir Dig 2022;35:e1648. - PMC - PubMed
    1. Schmidt C, Gerdes H, Hawkins W, Zucker E, Zhou Q, Riedel E et al. A prospective observational study examining quality of life in patients with malignant gastric outlet obstruction. Am J Surg 2009;1:92–99 - PubMed

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