Gastric Partitioning Gastrojejunostomy in Unresectable Distal Gastric Cancer Patients

Lee, Ha Gyoon; Kwon, Sung Joon

Abstract

PURPOSE
The main purpose of bypass surgery in unresectable distal gastric cancer is the improvement in the quality of life (QOL) of the patient. However, the results of a conventional gastroenterostomy are very dismal often as a consequence of continuous bleeding due to the contact of food material on the tumor surface and early obstruction of the stoma by the tumor growth. The development of more effective surgery is warranted for the improvement of the QOL in such patients. METHODS: Surgery was performed in 1, 158 cases gastric cancer, between March 1993 and July 2002, at the Hanyang University Medical Center. 54 of these cases (4.7%) were unresectable. Various kinds of gastro-jejunostomy (G-Jstomy) including conventional G-Jstomy (CGJ)(n=18), antral exclusion G-Jstomy (AEGJ) (n=7), and gastric partitioning G-Jstomy (GPGJ) (n=17) were performed. In this study, comparisions of the survival and postoperative QOL were performed between the CGJ and GPGJ group. RESULTS: The median survival durations were 120 and 209 days in the CGJ and GPGJ groups, respectively, and the difference the 2 groups was statistically significant (P=0.046). The postoperative body weight losses were 9.3% and 3.1% in the CGJ and GPGJ groups, respectively, with the differences showing borderline significance (P=0.067). In the GPGJ group, the volume of the blood transfusion during the postoperative period was much decreased compared to that of the preoperative period, but this was not found in the CGJ group. Although the numbers of cases were small and the clinicopathological profiles between two groups differnt, a GPGJ could minimize the food contact on the tumor surface, resulting in a decrease in the volume of postoperative blood transfused, smaller weight losses, and longer survival duration, compared to those with a CGJ. CONCLUSION: A gastric partitioning gastrojejunostomy can be recommended as the choice of bypass surgery in unresectable distal gastric cancer due to the superiority of the various clinical aspects.