Clinical outcome and indications for palliative gastrojejunostomy in unresectable advanced gastric cancer: Multi-institutional retrospective analysis

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.