Survival Analysis of Optimal Management in Incurable Gastric Cancer with Gastric Outlet Obstruction: A Two-Center Retrospective Study in Thailand

Abstract

Background: Gastric cancer frequently detected at an incurable stage, is often accompanied by gastric outlet obstruction (GOO). The optimal management of GOO in patients with incurable gastric cancer remains controversial. Objective: To evaluate the surgical outcomes of different treatment approaches to explore optimal procedures to manage this condition. Materials and Methods: A retrospective review was conducted on incurable gastric cancer patients with GOO at Ramathibodi Hospital, and at the National Cancer Institute of Thailand. Patients were categorized into three groups, namely resection, gastrojejunostomy, and feeding jejunostomy (FJ) or naso-jejunostomy (NJ) tube placement. Overall survival (OS), overall complications, Gastric Outlet Obstruction Scoring System (GOOSS) results after the operation and other relevant variables were recorded. Results: Of 44 patients included in the final analysis, the median OS was ten months for the resection group, six months for the FJ/NJ group, and 13 months for the gastrojejunostomy group (p=0.228). Postoperative complications were similar across the groups, although tube-related complications were notably higher in the FJ/NJ group. GOOSS scores were similar between the resection and the bypass groups. No treatmentrelated mortality was observed in any of the procedures. Conclusion: Among incurable gastric cancer patients who underwent resection, gastrojejunostomy, or FJ/NJ tube placement for GOO relief, the present study found no significant difference in the OS or overall complications. Both resection and gastrojejunostomy bypass are effective in relieving obstruction and yield comparable outcomes.