title: Clinical outcome and indications for palliative gastrojejunostomy in unresectable advanced gastric cancer: multi-institutional retrospective analysis.
abstract: BACKGROUND
  Palliative gastrojejunostomy (GJJ) for gastric outlet obstruction (GOO) associated with unresectable advanced gastric cancers (UAGC) is the most commonly used treatment modality, but its indication remains controversial. In this multi-institutions study, we investigated the clinical outcome of GJJ for UAGC and predictors of outcome and survival.
  
  
  METHODS
  A retrospective analysis was performed on 211 patients who underwent palliative GJJ for GOO caused by UAGC from 29 institutions between 2007 and 2009. Operative outcome including postoperative morbidity, mortality, assessment of oral intake by GOO Scoring System (GOOSS) and survival time were recorded. Prognostic factors for overall survival and risk factors for hospital death were investigated by univariate and multivariate analyses.
  
  
  RESULTS
  Postoperative oral food intake was recorded in 203 (96 %) patients. The average GOOSS improved from 1.1 at baseline to 2.5 at 1 month after surgery and remained above 2 for up to 6 months. Overall morbidity, 30-day mortality and hospital death rates were 22, 6 and 11 %, respectively. Median survival time was 228 days and 1-year survival rate was 31 %. Poor performance status (PS), prior chemotherapy and high C-reactive protein (CRP) level were significant independent predictors of poor survival. Poor PS and high CRP were also identified as significant risk factors of hospital death.
  
  
  CONCLUSIONS
  Palliative GJJ is beneficial for GOO caused by UAGC in terms of improvement of oral food intake, with acceptable morbidity and mortality. However, its indication for patients with poor PS, high CRP level, and a history of chemotherapy is less clear.
authors.affiliation: Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takeno
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Junya
authors.initials: J
authors.lastname: Fujita
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Tamura
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Fujitani
authors.forename: Jin
authors.initials: J
authors.lastname: Matsuyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000401:mortality*; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D008297:Male; D009017:Morbidity; D009367:Neoplasm Staging; D010166:Palliative Care; D011183:Postoperative Complications; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D015996:Survival Rate