P-0083 - Devine gastric exclusion: for a better palliation in pyloric obstruction

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Gastric Cancer
Palliative Care
Presenter Sara Carvalhal
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors S. Carvalhal1, C. Santos2, R. Oom2
  • 1Portuguese Institute of Oncology, Lisboa/PT
  • 2Portuguese Institute of Oncology, Lisbon/PT

Abstract

Introduction

Gastric cancer is 4th most common cancer in men and 5th in women. Surgery can be curative only in 36 to 50% of patients and the 5 year survival rate is low, especially in western countries. Therefore palliative surgery has an important role in case of bleeding and pyloric obstruction. The aim of this study was to compare the gastric exclusion and gastrojejunostomy as a method for palliation in patients with unresectable distal gastric cancer.

Methods

Between 2007 and 2013 patients diagnosed with gastric or other cancers with pyloric obstruction, deemed unresectable intra-operative, were submitted to gastric exclusion according to the technique described in 1925 by Devine and modified in 1936 by Maingot. It consists in the transection of the body of the stomach, excluding the tumor obstructing the pylorus, followed by end-to-side gastrojejunostomy. The results were compared to gastrojejunostomy. For the statistical analysis we used X2 test and Mann-Whitney test.

Results

Ten patients (6 men, 4 women) were included in the study, 5 had a gastric exclusion and 5 had a gastrojejunostomy. The median age was 63 years (45-77, interquartile range) and 68 years (60-75), respectively. There was one case of morbidity in each group (p = 0,197). The median length of stay was 5 days (4-7) in the gastric exclusion group and 7 days (6-18) in the gastrojejunostomy group (p = 0,092). There was a statistically significant difference in the time to oral diet (p = 0,038). We also observed a longer survival rate in the exclusion group although not significant.

Conclusion

The results suggest that the gastric exclusion is better than the gastrojejunostomy as a palliative surgery for pyloric obstruction. This technique, described 88 years ago, shows improved functional outcome and a low rate of complications, proving to be a safe option for these patients.