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Treatment option of endoscopic stent insertion or gastrojejunostomy for gastric outlet obstruction due to gastric cancer: a propensity score-matched analysis.

内镜支架置入或胃空肠吻合术治疗胃癌胃出口梗阻的治疗选择: 倾向评分匹配分析。

  • 影响因子:4.87
  • DOI:10.1007/s10120-020-01040-0
  • 作者列表:"Haga Y","Hiki N","Kinoshita T","Ojima T","Nabeya Y","Kuwabara S","Seto Y","Yajima K","Takeuchi H","Yoshida K","Kodera Y","Fujiwara Y","Baba H
  • 发表时间:2020-01-25
Abstract

BACKGROUND:There are currently two treatment options for gastric outlet obstruction (GOO) due to gastric cancer, endoscopic stenting and surgical gastrojejunostomy. However, their therapeutic effects have not yet been established. Therefore, the present study was undertaken to examine these effects. METHODS:The Japanese Gastric Cancer Association invited its delegates to participate in a retrospective multicenter cohort study on patients with GOO due to gastric cancer who underwent stent therapy or gastrojejunostomy in 2015. RESULTS:We obtained data from 85 patients undergoing stent therapy and 94 undergoing gastrojejunostomy from 42 hospitals. Baseline data revealed that stent patients had lower food intake, poorer performance status, and worse prognostic indices than gastrojejunostomy patients. Postoperative food intake and survival times were worse in stent patients than in gastrojejunostomy patients. We performed propensity score matching to select pairs of patients with similar baseline characteristics in the two treatment groups. After matching, the frequency of postoperative complications was significantly less in stent patients (3%, 1/33) than in gastrojejunostomy patients (21%, 7/34; p = 0.03). A low residue or full diet was achieved by 97% of stent patients (32/33) and 97% of gastrojejunostomy patients (33/34) (p = 0.98). Median survival times were 7.8 months in stent patients and 4.0 months in gastrojejunostomy patients (p = 0.38). CONCLUSIONS:Propensity score matching demonstrated that endoscopic stent placement resulted in less postoperative morbidity than and a similar food intake and equivalent survival times to gastrojejunostomy. These results suggest the utility of stent therapy.

摘要

背景: 目前对于胃癌引起的胃出口梗阻 (GOO) 有两种治疗选择,即内镜下支架置入术和外科胃空肠吻合术。然而,它们的治疗效果尚未确立。因此,本研究是为了检验这些影响。 方法: 日本胃癌协会邀请其代表参加一项回顾性多中心队列研究,研究对象为 2015年行支架治疗或胃空肠吻合术的胃癌伴 GOO 患者。 结果: 我们从 42 家医院获得了 85 例支架治疗患者和 94 例胃空肠吻合术患者的数据。基线数据显示,与胃空肠吻合术患者相比,支架患者的食物摄入量较低,性能状态较差,预后指数较差。术后进食和存活时间支架患者比胃空肠吻合术患者差。我们进行倾向评分匹配,在两个治疗组中选择基线特征相似的患者对。匹配后,支架患者术后并发症发生率 (3%,1/33) 明显低于胃空肠吻合术患者 (21%,7/34; p = 0.03)。97% 的支架患者 (32/33) 和 97% 的胃空肠吻合术患者 (33/34) 实现了低残留或全饮食 (p = 0.98)。支架患者的中位生存期为 7.8 个月,胃空肠吻合术患者的中位生存期为 4.0 个月 (p = 0.38)。 结论: 倾向评分匹配表明,内镜支架置入术后发病率低于胃空肠吻合术,摄食量和等效生存时间相似。这些结果提示支架治疗的效用。

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