Gastric partitioning gastrojejunostomy in unresectable distal gastric cancer patients

The main purpose of bypass surgery in patients with unresectable distal gastric cancer is to improve their quality of life (QoL). However, the result of conventional gastroenterostomy is dismal including continuous bleeding due to the contact of food material on the tumor surface and early obstruction of the stoma by tumor growth. Developing more effective surgery is warranted to improve the QoL of these patients. Among the 1158 patients with gastric cancer who underwent surgery from March 1993 to July 2002 at Hanyang University Medical Center, 54 (4.7%) had unresectable cancers. Various types of gastrojejunostomy (G-Jstomy), including conventional G-Jstomy (CGJ) (n = 18), antral exclusion G-Jstomy (n = 7), and gastric partitioning G-Jstomy (GPGJ) (n = 17), as well as exploratory laparotomy only (n = 12) were performed in these unresectable cases. In this study, survival and postoperative QoL were compared for the CGJ and GPGJ groups. The median survivals were 120 and 209 days for the CGJ and GPGJ groups, respectively (p = 0.046). The rates of postoperative body weight loss compared to the preoperative weight were 9.3% and 3.1% in the CGJ and GPGJ groups, respectively; the difference showed borderline significance (p = 0.067). The volume of blood transfusion was much less during the postoperative period than during the preoperative period in the GPGJ group but not in the CGJ group. The GPGJ procedure minimized food contact on the tumor surface, which was confirmed by an upper gastrointestinal barium meal series. GPGJ can be recommended as the procedure of choice for bypass surgery in patients with unresectable distal gastric cancer considering their improved survival and postoperative QoL compared to those who underwent CGJ.