Proximal gastric exclusion for unresectable gastric cancer.
BACKGROUND
Patients with unresectable distal gastric cancer causing obstruction have classically undergone palliative gastrojejunostomy, but high mortality rates and delayed return of gastric emptying have been reported. The aim of the present study was to compare gastrojejunostomy and proximal gastric exclusion in patients with unresectable distal gastric cancer.


METHODS
Until 1996, patients with unresectable obstructing distal gastric cancer underwent antecolic gastrojejunostomy, but since 1997 we have performed proximal gastric exclusion for these patients. Mortality, morbidity, time taken to resume oral fluids and normal diet, length of palliation and survival were compared.


RESULTS
There was no mortality in either the gastrojejunostomy group (n = 4) or the exclusion group (n = 6). A single patient in the gastrojejunostomy group developed a sacral sore and another patient had recurrent vomiting following gastrojejunostomy. Exclusion resulted in a quicker return to diet and a slightly longer survival, although these were not statistically significant.


CONCLUSIONS
Proximal gastric exclusion offers a safe, quick and life-enduring palliation for unresectable malignant gastric outlet obstruction.
Dolan
Kevin
K
Department of Surgery, The General Infirmary at Leeds, Leeds, United Kingdom. medkd@iprimus.com.au
Sue-Ling
Henry
H
D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000379:methods; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome