TY - JOUR
T1 - Palliative treatment for malignant gastrointestinal obstruction with peritoneal carcinomatosis
T2 - Enteral stenting versus surgery
AU - Jaruvongvanich, Veeravich
AU - Chesta, F. N.U.
AU - Baruah, Anushka
AU - Oberoi, Meher
AU - Adamo, Daniel
AU - Singh, Prabh G.
AU - Meyer, Alyssa
AU - Law, Ryan J.
AU - Buttar, Navtej
N1 - Publisher Copyright:
© 2020 Georg Thieme Verlag. All rights reserved.
PY - 2020/10/1
Y1 - 2020/10/1
N2 - Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms. Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2% versus 95%), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P <0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5% vs. 50%), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P <0.05). The need for more than one stent was associated with a higher likelihood of stent failure. Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.
AB - Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse events between endoscopic and surgical palliation and identify predictors of stent success in patients with MGIO with PC. Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative surgery or enteral stenting were included. Clinical success was defined as relief of obstructive symptoms. Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared. The two groups did not differ in rates of technical success, 30-day mortality, or recurrence. Clinical success from a single intervention (63.2% versus 95%), luminal patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days) favored palliative surgery (all P <0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5% vs. 50%), the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral stenting (P <0.05). The need for more than one stent was associated with a higher likelihood of stent failure. Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital stay than palliative surgery, although unlike other MGIOs, clinical success is lower in MGIO with PC. Identification of the right candidates and potential predictors of clinical success in ECOG-matched large-scale studies is needed to validate these results.
UR - http://www.scopus.com/inward/record.url?scp=85106143540&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85106143540&partnerID=8YFLogxK
U2 - 10.1055/a-1237-3956
DO - 10.1055/a-1237-3956
M3 - Article
AN - SCOPUS:85106143540
SN - 2196-9736
VL - 8
SP - E1487-E1494
JO - Endoscopy International Open
JF - Endoscopy International Open
IS - 10
ER -