Bypass Surgery in Unresectable Distal Gastric Cancer

Kwon, Sung Joon

Abstract

BACKGROUND: The main purpose of bypass surgery in unresectable distal gastric cancer is to improve quality of life. However, the results of a conventional gastro-enterostomy are very dismal and include continuous bleeding due to contact of food material with the tumor surface and early obstruction of the stoma by tumor growth.
METHODS
Eight hundred sixty two gastric-cancer patients were operated on between June 1992 and July 1999 at the Department of General Surgery, Hanyang University Medical Center, and 3.7% (32/862 cases) of them were unresectable. In this study, various kinds of gastro-jejunostomies (G-Jstomies), including conventional G-Jstomies (n=14), antral exclusion G-Jstomies (n=7), and gastric partitioning G-Jstomies (n=5) were retrospectively compared based on of survival and postoperative quality of life. Palliative gastrectomy cases (n=111) and explo-laparotomy only cases (n=6) were used as a control group for this study.
RESULTS
The mean survival duration of the palliative gastrectomy group (20 2 months) was longer than those of the G-Jstomy (7 1 months) and the explo-laparotomy (4 1 months) groups (P=0.0000). However, there was no survival difference according to the type of G-Jstomy, and there was no statistically significant difference in hospital stay, diet start date, postoperative transfusion volume, or body weight change. Although the number of cases was too small and the clinicopathological profiles were not similar among the various G-Jstomy groups, the gastric partitioning G-Jstomy was very useful for endoscopically evaluating the tumor and for minimizing food contact with the tumor surface.
CONCLUSIONS
The gastric partitioning G-Jstomy can be recommended as the choice of bypass surgery for unresectable distal gastric cancer due to its superiority in some aspects.