The Outcome and Survival of Locally Advanced Gastric Cancer with Gastric Outlet Obstruction After Upfront Radical Surgery.

Abstract

Background: Carcinoma stomach with gastric outlet obstruction (GOO) is generally considered an advanced disease, with a focus on palliative treatment options. But, in the Eastern population, the tumor often originates in the antropyloric region resulting in comparatively early occurrence of GOO. The management of such resectable cases is not clearly defined in literature. In this study, we analyzed the surgical outcome and survival of upfront D2 gastrectomy combined with adjuvant chemotherapy in these cases.

Methods: This study enrolled consecutive patients with carcinoma stomach accompanied by GOO from April 2018 to March 2022. The feasibility of radical surgery, clinicopathological profile, and factors affecting postoperative morbidity were analyzed. Two-year overall survival (OS) and associated factors were assessed using Kaplan-Meier survival analysis and the Cox proportional hazard model.

Results: Among 119 gastric carcinoma patients, 78 presented with GOO. After excluding metastatic disease (18), locally unresectable disease (5), and neo-adjuvant therapy (3), 52 patients underwent radical gastrectomy. Post-operative morbidity and 90-day mortality were 32.7% and 0%, respectively. Factors affecting morbidity were low hemoglobin levels (p = 0.024) and type of procedure (subtotal vs. total gastrectomy) (p = 0.04). A total of 78.8% patients completed fluoropyrimidine-based adjuvant chemotherapy. The 2-year OS was 59.3% and non-completion of adjuvant chemotherapy (HR 2.68, p = 0.038) and poor tumor differentiation (HR 2.77, p = 0.015) were linked to worse OS.

Conclusion: Upfront radical surgery in resectable carcinoma stomach with GOO is a feasible treatment option with acceptable good surgical and oncological outcomes. With combined adjuvant chemotherapy, a reasonable survival rate is observed.