title: Palliative distal gastrectomy offers no survival benefit over gastrojejunostomy for gastric cancer with outlet obstruction: retrospective analysis of an 11-year experience.
abstract: BACKGROUND
  Either palliative distal gastrectomy or gastrojejunostomy are the initial treatment options for locally advanced gastric cancer with outlet obstruction when curative-intent resection is not feasible. Since chemotherapy is the mainstay for unresectable gastric cancer, the clinical value of palliative distal gastrectomy is controversial.
  
  
  METHODS
  We retrospectively reviewed the clinical data of patients with gastric cancer with outlet obstruction treated at our institution between January 2002 and December 2012. We compared the clinical outcomes of palliative distal gastrectomy with those of gastrojejunostomy patients and the factors affecting overall survival were evaluated.
  
  
  RESULTS
  Elective palliative distal gastrectomy and gastrojejunostomy were performed in 18 and 25 patients, respectively. The median overall survival times in the gastrojejunostomy and palliative distal gastrectomy groups were statistically equivalent at 8.8 and 8.3 months, respectively (P = 0.73), despite the more locally advanced tumors in the gastrojejunostomy as compared with the palliative distal gastrectomy group. A multivariate Cox regression analysis showed absence of postoperative chemotherapy and higher postoperative complication grade to be associated with worse clinical outcomes.
  
  
  CONCLUSIONS
  Palliative distal gastrectomy offers neither survival nor palliative benefit as compared to gastrojejunostomy. Minimizing the morbidity of intervention for outlet obstruction, followed by chemotherapy, appears to be the optimal initial strategy for incurable gastric cancer with outlet obstruction.
authors.affiliation: Department of Gastrointestinal Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. okumura-tky@umin.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Okumura
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Yamashita
authors.forename: Susumu
authors.initials: S
authors.lastname: Aikou
authors.forename: Koichi
authors.initials: K
authors.lastname: Yagi
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Yamagata
authors.forename: Masato
authors.initials: M
authors.lastname: Nishida
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Mori
authors.forename: Sachiyo
authors.initials: S
authors.lastname: Nomura
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Seto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D017219:Gastric Outlet Obstruction; D005774:Gastrostomy / Q000401:mortality*; D006801:Humans; D007582:Jejunostomy / Q000401:mortality*; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate