title: Surgical management of patients with bowel obstructions secondary to gastric cancer.
abstract: OBJECTIVE
  To assess whole-body fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the management of small bowel obstructions (SBOs) secondary to gastric cancer and its role in treatment strategies.
  
  
  METHODS
  The medical records of all of the patients who were admitted for an intestinal obstruction after curative resection for gastric cancer were retrospectively reviewed. PET/CT was performed before a clinical treatment strategy was established for each patient. The patients were divided into 2 groups: patients with no evidence of a tumor recurrence and patients with evidence of a tumor recurrence. Tumor recurrences included a local recurrence, peritoneal carcinomatosis or distant metastases. The primary endpoint was the 1-year survival rate, and other variables included patient demographics, the length of hospital stay, complications, and mortality.
  
  
  RESULTS
  The median time between a diagnosis of gastric cancer and the detection of a SBO was 1.4 years. Overall, 31 of 65 patients (47.7%) had evidence of a tumor recurrence on the PET/CT scan, which was the only factor that was associated with poor survival. Open and close surgery was the main type of surgical procedure reported for the patients with tumor recurrences. R0 resections were performed in 2 patients, including 1 who underwent combined adjacent organ resection. In the group with no evidence of a tumor recurrence on PET/CT, bowel resections were performed in 7 patients, adhesiolysis was performed in 7 patients, and a bypass was performed in 1 patient. The 1-year survival curves according to PET/CT evidence of a tumor recurrence vs no PET/CT evidence of a tumor recurrence were significantly different, and the 1-year survival rates were 8.8% vs 93.5%, respectively. There were no significant differences (P = 0.71) in the 1-year survival rates based on surgical vs nonsurgical management (0% with nonoperative treatment vs 20% after exploratory laparotomy).
  
  
  CONCLUSIONS
  (18)F-FDG PET/CT can be used to identify the causes of bowel obstructions in patients with a history of gastric cancer, and this method is useful for planning the surgical management of these patients.
authors.affiliation: Laboratory of General Surgery, Department of General Surgery, Xinhua Hospital, Affiliated to School of Medicine, Shanghai Jiaotong University, Shanghai 200092, China.
authors.forename: Wen-Guang
authors.initials: WG
authors.lastname: Wu
authors.forename: Ping
authors.initials: P
authors.lastname: Dong
authors.forename: Xiang-Song
authors.initials: XS
authors.lastname: Wu
authors.forename: Mao-Lan
authors.initials: ML
authors.lastname: Li
authors.forename: Qi-Chen
authors.initials: QC
authors.lastname: Ding
authors.forename: Lin
authors.initials: L
authors.lastname: Zhang
authors.forename: Jia-Hua
authors.initials: JH
authors.lastname: Yang
authors.forename: Hao
authors.initials: H
authors.lastname: Weng
authors.forename: Qian
authors.initials: Q
authors.lastname: Ding
authors.forename: Zhu-Jun
authors.initials: ZJ
authors.lastname: Tan
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Lu
authors.forename: Jun
authors.initials: J
authors.lastname: Gu
authors.forename: Ying-Bin
authors.initials: YB
authors.lastname: Liu
mesh_terms: D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Clinical treatment strategy; Gastric cancer; Positron emission tomography/computed tomography; Small bowel obstructions
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