Stomach-partition as bridge to curative treatment in locally advanced gastric cancer: a case series

Introduction Globally, gastric cancer is frequently diagnosed at an advanced stage. Current multimodal treatment, including perioperative systemic therapy and radical resection, offer the best chance of survival. Patients with distal tumours often present with gastric outlet obstruction (GOO), with consequent reduction or impossibility of an adequate oral intake. The aim of this study was to evaluate the use of stomach-partition gastrojejunostomy (SPGJ) to restore oral intake in patients with locally advanced antral tumours as part of multimodal treatment, with a curative intent. Methods This is a case series of patients with GOO syndrome due to non-metastatic distal gastric tumours, who underwent SPGJ, as a bridge to curative treatment, between 2015 and 2021. Baseline clinicopathological characteristics including age, nutritional status, body mass index and performance status were evaluated. Obstructive symptoms were graded according to the GOO Scoring System and evaluated before and after the surgery. The primary outcomes were: surgical complications, mortality and lenght of hospital stay. Results This case series included 12 patients who underwent open SPGJ. Most patients were male (9/12) and with a mean age of 69 and a mean BMI of 23.4. GOO scores improved in all patients. Postoperative complications occurred in four patients (40%), requiring surgical intervention in one case, for intra-abdominal bleeding. One patient died during the early postoperative period due to complications of aspiration pneumonia and another patient two months later due to cardiac failure. The mean length of hospital stay was thirteen days. Chemotherapy was administered to 8 (67%) patients, of whom five (63%) later underwent radical resection. Median survival times were 30 months. Conclusion Stomach-partition gastrojejunostomy seems a safe and feasible option to restore short-term oral intake in patients with clinically significant gastric outlet obstruction, this might improve the number of eligible patients to complete the recommended treatment and consequently improve oncological outcomes and quality of life.