Feasibility of self-expandable metallic stent plus chemotherapy for metastatic gastric cancer with pyloric stenosis.
OBJECTIVE
Self-expandable metallic stent placement is accepted as palliative therapy for advanced gastric cancer with gastric outlet obstruction, but data are lacking for chemotherapy after self-expandable metallic stent insertion. This study retrospectively compared results between surgery plus chemotherapy and stenting plus chemotherapy for metastatic gastric cancer with pyloric stenosis.


METHODS
Subjects comprised 26 patients who received chemotherapy after surgery or endoscopic stenting for metastatic gastric cancer with pyloric stenosis between April 2000 and December 2007 in four Japanese hospitals. Patients were categorized into two groups: 15 patients who received chemotherapy after surgery for pyloric stenosis (Surgery group); and 11 patients who received chemotherapy after self-expandable metallic stent placement for pyloric stenosis (Stent group).


RESULTS
Median survival time and median time to treatment failure were 284 days and 226 days in the Surgery group and 337 days and 247 days in the Stent group, respectively. No significant differences were noted between survival and time to treatment failure. No significant differences were found in median oral intake rate (Surgery, 93.1%; Stent, 93.2%) or median hospital stay rate (Surgery, 24.6%; Stent, 23.7%) during survival. Response rate was 45.5% in the Surgery group and 50% in the Stent group, with no significant difference. Likewise, no significant differences were noted between groups for frequencies of toxicity or complications.


CONCLUSIONS
The present results suggest that chemotherapy after stenting is as effective and safe as chemotherapy after surgery. Stents may replace surgery in combination therapy with chemotherapy for metastatic gastric cancer with gastric outlet obstruction.
Shimura
Takaya
T
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. tshimura@med.nagoya-cu.ac.jp
Kataoka
Hiromi
H
Sasaki
Makoto
M
Yamada
Tomonori
T
Hayashi
Kazuki
K
Togawa
Shozo
S
Okumura
Fumihiro
F
Kubota
Eiji
E
Ohara
Hirotaka
H
Joh
Takashi
T
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D004435:Eating; D005240:Feasibility Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects; D015390:Gastric Bypass; D005773:Gastroscopy / Q000009:adverse effects; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008670:Metals; D008875:Middle Aged; D010166:Palliative Care; D011474:Prosthesis Design; D011707:Pyloric Stenosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D018570:Risk Assessment; D015607:Stents; D013274:Stomach Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D013997:Time Factors; D017211:Treatment Failure
D008670:Metals