ArticleJournal of gastrointestinal oncology2025
Application of modified laparoscopic stomach-partitioning gastrojejunostomy for stage IV gastric cancer with gastric outlet obstruction.
Article in Journal of gastrointestinal oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Gastric outlet obstruction (GOO) is a common complication in stage IV gastric cancer, often causing malnutrition and delaying conversion therapy. Compared with conventional gastrojejunostomy (CGJ), stomach-partitioning gastrojejunostomy (SPGJ) offers advantages in improving oral intake and reducing gastric emptying disorders. In clinical practice, we found that performing No. 4sb lymph node dissection during the initial bypass procedure improves the surgical field for subsequent radical resection, eliminating the need to reoperate around the anastomosis and greater curvature. This significantly shortens operative time and facilitates recovery. We termed this approach as modified laparoscopic stomach-partitioning gastrojejunostomy (M-LSPGJ), incorporating No. 4sb lymph node dissection, gastrojejunostomy, and Braun anastomosis. In this retrospective study, 22 patients with stage IV gastric cancer and GOO underwent M-LSPGJ followed by conversion therapy with SOX (S-1 + oxaliplatin) or XELOX (capecitabine + oxaliplatin) plus programmed death-1 (PD-1) inhibitors. By postoperative day 30, 86.4% (19/22) resumed normal oral intake [Gastric Outlet Obstruction Scoring System (GOOSS) score =3], with a mean time to reach GOOSS score 2 of 4.5±2.1 days. Nine patients (40.9%) underwent second-stage radical gastrectomy, with R0 resection achieved in 8 (36.4%). The median overall survival (OS) for the entire cohort was 15.0 months. In patients who achieved R0 resection, the median OS was 30.5 months, compared to 10.4 months in the non-R0 group [hazard ratio (HR) =0.18, P=0.008]. M-LSPGJ effectively relieves symptoms and creates favorable conditions for curative resection in selected advanced gastric cancer patients, serving as a promising bridge from palliation to oncologic conversion.
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