-Report on Experiments and Clinical Cases-

Significance of Gastrectomy as Palliative Surgery for Gastric Carcinoma with Pyloric Stenosis

Satoshi Mizutani¹, Takeshi Shioya¹, Kentaro Maejima¹, Masanori Yoshino¹, Osamu Komine¹, Hideki Bou¹, Masao Ogata¹, Masanori Watanabe¹, Tetsuo Shibuya², Akira Tokunaga¹ and Takashi Tajiri³

¹Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital
²Omiya Medical Association Hospital, Saitama
³Surgery for Organ Function and Biology Regulation, Graduate School of Medicine, Nippon Medical School

We conducted a clinicopathological study of cases of gastric carcinoma with pyloric stenosis and examined treatment outcomes and the prognosis of cases of stage IV gastric carcinoma with pyloric stenosis and the validity of gastrectomy as palliative surgery in these cases. The outcomes of 49 surgeries for gastric carcinoma with pyloric stenosis were compared with those of 671 surgeries for gastric carcinoma without pyloric stenosis. The diagnosis of pyloric stenosis was confirmed with both upper gastrointestinal endoscopy and an upper gastrointestinal barium series. The frequency of pyloric stenosis in patients with gastric carcinoma was 7.3%. Serosal invasion was observed in about 70% of all cases. Of these cases, 53.1% were classified as stage IV. The resection rate was 73.5%, and the resection was classified as curative in 44.9% of cases. The incidence of complications after surgery in cases of stage IV gastric carcinoma was 47.1%. The median survival time was significantly greater in patients undergoing resection group than in those not undergoing resection (p=0.025). Most patients with gastric cancer and pyloric stenosis can be considered to have stage IV disease, which is associated with high rates of morbidity and mortality; thus, prevention of complications, and therefore, avoidance of gastrectomy is recommended in such patients. Nonetheless, in this study, gastrectomy was shown to improve prognoses in these patients.

J Nippon Med Sch 2007; 74: 241-245

Keywords
gastric carcinoma, pyloric stenosis, palliative surgery, prognosis

Correspondence to
Satoshi Mizutani, Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
mizutani@nms.ac.jp

Received, September 15, 2006
Accepted, February 21, 2007