Multimodality Therapy, Followed by Laparoscopic Gastrectomy, for Unresectable Gastric Cancer With Outlet Obstruction and Bulky N2 Metastases.

IF 1.1 4区医学 Q3 SURGERY

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Pub Date : 2023-12-01 DOI:10.1097/SLE.0000000000001242

Liangang Ma, Baocheng Zhao, Yudong Zhang, Shuai Jing, Hao Qu

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引用次数: 0

Abstract

Background: Patients who have gastric cancer with outlet obstruction (GCOO) and bulky N2 metastases cannot undergo curative resection and tolerate chemotherapy poorly, which may be improved by multimodality therapy (MMT) combined with laparoscopic gastrectomy.

Patients and methods: The records of patients with GCOO and bulky N2 metastases who received MMT including nasojejunal feeding combined with preoperative chemotherapy (PCT), followed by laparoscopic exploration [enteral nutritional (EN) group] in sequence or laparoscopic gastrojejunostomy (LGJ) before PCT plus laparoscopic gastrectomy (LGJ group) were retrospectively reviewed. Prognostic Nutritional Index, gastric outlet obstruction scoring system grade, quality of life, response to PCT, surgical outcomes, and long-term survival were analyzed.

Results: Fifty-four consecutive patients with GCOO and bulky N2 metastases were identified. The Prognostic Nutritional Index and Nutritional Risk Screening-2002 score of patients were significantly improved as a result of multimodal therapy, but no superiority was demonstrated between the EN group and the LGJ group. The quality of life (52.6 ± 11.4 vs 68.2 ± 13.5, P = 0.036) and gastric outlet obstruction scoring system (P < 0.05) of patients in the LGJ group were better compared with the EN group. The rate of laparoscopic D2 gastrectomy (94.3% vs 92.9%, P = 0.64) and R0 resection (91.4% vs 92.9%, P = 0.53) in the EN group was similar to the LGJ group. There were no significant differences for the 5-year overall survival rate (63.2% vs 57.1, P = 0.86) and the 5-year relapse-free survival rate (42.9% vs 53.8%, P = 0.54) of patients in the EN group compared with the LGJ group.

Conclusions: MMT including EN support or laparoscopic gastrojejunostomy followed by laparoscopic D2 gastrectomy is a feasible and effective treatment for patients with GCOO and bulky N2 metastases.

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对有出口梗阻和大块 N2 转移的无法切除的胃癌进行多模式疗法，然后进行腹腔镜胃切除术。

背景胃癌伴出口梗阻（GCOO）和大块N2转移灶患者无法接受根治性切除术，对化疗的耐受性较差，多模式疗法（MMT）联合腹腔镜胃切除术可改善患者的耐受性：回顾性研究了GCOO和大块N2转移灶患者的病历，这些患者接受了包括鼻空肠进食在内的多模式疗法，并结合术前化疗（PCT），随后依次进行腹腔镜探查（肠内营养（EN）组）或在PCT加腹腔镜胃切除术前进行腹腔镜胃空肠造口术（LGJ）（LGJ组）。对预后营养指数、胃出口梗阻评分系统分级、生活质量、对PCT的反应、手术效果和长期生存进行了分析：结果：共发现54例连续性胃出口梗阻和大块N2转移灶患者。多模式疗法显著改善了患者的预后营养指数和营养风险筛查-2002评分，但EN组与LGJ组之间未显示出优越性。LGJ 组患者的生活质量（52.6 ± 11.4 vs 68.2 ± 13.5，P = 0.036）和胃出口梗阻评分系统（P < 0.05）优于 EN 组。EN组的腹腔镜D2胃切除术率（94.3% vs 92.9%，P = 0.64）和R0切除率（91.4% vs 92.9%，P = 0.53）与LGJ组相似。与LGJ组相比，EN组患者的5年总生存率（63.2% vs 57.1，P = 0.86）和5年无复发生存率（42.9% vs 53.8%，P = 0.54）无明显差异：包括EN支持或腹腔镜胃空肠造口术在内的MMT，再加上腹腔镜D2胃切除术，是治疗GCOO和大块N2转移灶患者的一种可行且有效的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgical Laparoscopy, Endoscopy & Percutaneous Techniques 医学-外科

CiteScore

2.00

自引率

10.00%

发文量

103

审稿时长

3-8 weeks

期刊介绍： Surgical Laparoscopy Endoscopy & Percutaneous Techniques is a primary source for peer-reviewed, original articles on the newest techniques and applications in operative laparoscopy and endoscopy. Its Editorial Board includes many of the surgeons who pioneered the use of these revolutionary techniques. The journal provides complete, timely, accurate, practical coverage of laparoscopic and endoscopic techniques and procedures; current clinical and basic science research; preoperative and postoperative patient management; complications in laparoscopic and endoscopic surgery; and new developments in instrumentation and technology.