Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Rome, Italy.
Am J Surg. 2013 Aug;206(2):210-7. doi: 10.1016/j.amjsurg.2012.08.018. Epub 2013 Jun 2.
The authors report the final results of a prospective single-center randomized study whose aim was to compare the endoscopic placement of self-expandable stents with open surgical gastroenterostomy to relieve gastric outlet obstruction (GOO) in patients with advanced antropyloric adenocarcinoma. A systematic review of the medical literature from December 1999 to December 2011 was carried out to determine the results of endoscopic stenting in patients with GOO from unresectable primary cancer of the antropyloric region.
In the prospective study, 18 patients with advanced adenocarcinoma of the antropyloric region and symptoms of GOO were enrolled. In 9 patients, self-expandable stents were placed, and in 9 patients, open surgical gastroenterostomy was performed. Patients were followed until death. Six hundred seventy-two patients with primary unresectable cancer of the antropyloric region and GOO syndrome who underwent endoscopic stenting were identified from the literature.
In the prospective study of 18 patients, there was no case of postprocedural mortality. Efficient gastric emptying resumed more quickly in patients who received stents, although 3 months after the procedures, there was no difference between the 2 groups. Mean crude survival was 258 days in patients who received stents and 283 days in those who underwent surgical gastroenterostomy (P = NS). In patients who underwent stent placement, there were 2 cases of stent migration and 2 cases of food impaction, which were resolved with endoscopy at a mean follow-up of 70 days. In the 672 patients from the literature, operative mortality and morbidity were very low. In prospective studies, complications related to stents were more common than previously thought.
Endoscopic placement of metallic stents offers an effective therapy in patients with advanced primary adenocarcinoma of the antropyloric region and poor general condition. In patients with longer life expectancies, the form of therapy should be chosen individually, considering that surgical gastroenterostomy has fewer complications in the medium term and that in patients with endoscopic stenting, very careful follow-up is required, with the possibility of new operative endoscopy in half of the patients.
作者报告了一项前瞻性单中心随机研究的最终结果，该研究旨在比较内镜下自膨式支架置入与剖腹手术胃空肠吻合术治疗晚期胃幽门腺癌所致胃出口梗阻（GOO）的疗效。作者对 1999 年 12 月至 2011 年 12 月的医学文献进行了系统回顾，以确定内镜支架置入治疗无法切除的胃幽门区原发性癌症所致 GOO 患者的结果。
在前瞻性研究中，纳入 18 例胃幽门区晚期腺癌并伴有 GOO 症状的患者。其中 9 例行自膨式支架置入，9 例行剖腹手术胃空肠吻合术。患者随访至死亡。通过文献检索，共纳入 672 例无法切除的胃幽门区原发性癌症伴 GOO 综合征且行内镜支架置入的患者。
在 18 例患者的前瞻性研究中，无术后死亡病例。接受支架置入的患者胃排空恢复更快，但在术后 3 个月时，两组间无差异。接受支架置入的患者中位粗生存率为 258 天，行剖腹手术胃空肠吻合术的患者为 283 天（P=NS）。接受支架置入的患者中有 2 例支架移位和 2 例食物嵌塞，在平均 70 天的随访中通过内镜解决。在文献中的 672 例患者中，手术死亡率和发病率均较低。在前瞻性研究中，与支架相关的并发症比以前认为的更为常见。
在一般状况较差的晚期胃幽门区原发性腺癌患者中，金属支架置入是一种有效的治疗方法。对于预期寿命较长的患者，应根据个体情况选择治疗方式，因为剖腹手术胃空肠吻合术在中期并发症较少，而行内镜支架置入术的患者需要非常仔细的随访，半数患者可能需要再次行内镜手术。
