Tanaka Tsuyoshi, Suda Koichi, Nakauchi Masaya, Fujita Masahiro, Suzuki Kazumitsu, Umeki Yusuke, Serizawa Akiko, Akimoto Shingo, Watanabe Yusuke, Shibasaki Susumu, Matsuoka Hiroshi, Inaba Kazuki, Uyama Ichiro
Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Japan.
Surg Endosc. 2025 Feb;39(2):837-849. doi: 10.1007/s00464-024-11427-0. Epub 2024 Dec 2.
Advanced gastric cancer with gastric outlet obstruction (GOO) causes malnutrition and medication adherence issues, leading to a poor prognosis. We developed a novel multimodal, less invasive treatment approach for gastric cancer patients with symptomatic GOO: laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ) combined with neoadjuvant chemotherapy (NAC), followed by minimally invasive gastrectomy with reuse of gastrojejunostomy. This study is a retrospective analysis of the safety and feasibility of our treatment strategy.
In this single-institution retrospective study, we enrolled 54 patients (NAC group, n = 26; upfront gastrectomy group, n = 28) who achieved R0 resection through a minimally invasive approach between 2007 and 2020 and evaluated their short- and long-term outcomes.
After LSPGJ, the Gastric Outlet Obstruction Scoring System score significantly improved (p < 0.001). The median relative dose intensity of NAC was 88.2%. Regarding short-term outcomes, there were no differences in postoperative complications, length of postsurgical hospital stay, and adjuvant chemotherapy administration. Although overall survival and relapse-free survival showed trends toward improvement in the NAC group, these differences were not statistically significant. The cumulative incidence curve for recurrence in the NAC group was significantly lower than that of the upfront gastrectomy group (p = 0.041). Recurrence and hematogenous metastasis were significantly lower in the NAC group (p = 0.031 and 0.041, respectively) than in the upfront gastrectomy group. A forest plot revealed that NAC yielded favorable outcomes, particularly for patients with a body mass index (BMI) < 18.5 kg/m, cT4, or cN1.
LSPGJ combined with NAC followed by minimally invasive gastrectomy was a safe and feasible treatment strategy for patients with advanced gastric cancer with symptomatic GOO. This procedure may contribute to the early recovery of oral intake and help maintain NAC dose intensity, potentially improving prognosis, particularly for patients with low BMI and advanced-stage disease.
伴有胃出口梗阻（GOO）的进展期胃癌会导致营养不良和服药依从性问题，从而预后较差。我们为有症状性GOO的胃癌患者开发了一种新型多模式、微创治疗方法：腹腔镜胃分隔空肠吻合术（LSPGJ）联合新辅助化疗（NAC），随后进行微创胃切除术并重新利用空肠吻合术。本研究是对我们治疗策略的安全性和可行性的回顾性分析。
在这项单中心回顾性研究中，我们纳入了2007年至2020年间通过微创方法实现R0切除的54例患者（NAC组，n = 26； upfront胃切除术组，n = 28），并评估了他们的短期和长期结局。
LSPGJ术后，胃出口梗阻评分系统评分显著改善（p < 0.001）。NAC的中位相对剂量强度为88.2%。关于短期结局，术后并发症、术后住院时间和辅助化疗的使用方面没有差异。虽然NAC组的总生存期和无复发生存期有改善趋势，但这些差异无统计学意义。NAC组的复发累积发生率曲线显著低于 upfront胃切除术组（p = 0.041）。NAC组的复发和血行转移显著低于upfront胃切除术组（分别为p = 0.031和0.041）。森林图显示NAC产生了良好的结局，特别是对于体重指数（BMI）< 18.5 kg/m²、cT4或cN1的患者。
LSPGJ联合NAC随后进行微创胃切除术是有症状性GOO的进展期胃癌患者的一种安全可行的治疗策略。该手术可能有助于口服摄入的早期恢复，并有助于维持NAC剂量强度，潜在地改善预后，特别是对于低BMI和晚期疾病患者。
