Background

Patients with peritoneal dissemination of gastric cancer have poor oral intake caused by malignant bowel obstruction (MBO). Palliative surgery has often been undertaken to improve quality of life (QOL), but few prospective studies on palliative surgery in this patient population have been published.

Patients and methods

We prospectively investigated the significance of palliative surgery using patient-reported QOL measures. Patients underwent palliative surgery by small intestine/colon resection or small intestine/colon bypass or ileostomy/colostomy for MBO. The primary endpoint was change in QOL assessed at baseline, 14 days, 1 month, and 3 months following palliative surgery using the Euro QoL Five Dimensions (EQ-5D™) questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ-STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications.

Results

Between April 2013 and March 2018, 63 patients were enrolled from 14 institutions. The mean EQ-5D™ utility index baseline score of 0.6 remained consistent. Gastric-specific symptoms mostly showed statistically significant improvement from baseline. Forty-two patients (67%) were able to eat solid food 2 weeks after palliative surgery and 36 patients (57%) tolerated it for 3 months. The rate of overall morbidity of ≥ grade III according to the Clavien–Dindo classification was 16% (10 patients) and the 30-day postoperative mortality rate was 3.2% (2 patients).

Conclusions

In patients with MBO caused by peritoneal dissemination of gastric cancer, palliative surgery did not improve QOL while improving solid food intake, with an acceptable postoperative morbidity and mortality rate.

中文翻译：

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胃癌腹膜播散所致恶性肠梗阻姑息手术后生活质量评估：一项前瞻性多中心观察研究

背景

胃癌腹膜播散患者因恶性肠梗阻（MBO）导致经口摄入不足。姑息性手术通常用于提高生活质量 (QOL)，但很少有关于该患者群体姑息性手术的前瞻性研究发表。

患者和方法

我们使用患者报告的生活质量指标前瞻性地调查了姑息性手术的意义。患者通过小肠/结肠切除术或小肠/结肠旁路术或回肠造口术/结肠造口术进行 MBO 的姑息性手术。主要终点是使用 Euro QoL 五维 (EQ-5D™) 问卷和欧洲癌症研究与治疗组织生活质量问卷评估姑息性手术后基线、14 天、1 个月和 3 个月的 QOL 变化胃癌模块（QLQ-STO22）。次要终点是术后口服摄入量和手术并发症的改善。

结果

2013 年 4 月至 2018 年 3 月期间，来自 14 个机构的 63 名患者入组。0.6 的平均 EQ-5D™ 效用指数基线得分保持一致。与基线相比，胃特异性症状大多显示出统计学上的显着改善。姑息性手术 2 周后 42 名患者 (67%) 能够吃固体食物，36 名患者 (57%) 能够耐受 3 个月。根据 Clavien-Dindo 分类，≥ III 级的总体发病率为 16%（10 名患者），术后 30 天死亡率为 3.2%（2 名患者）。

结论

在胃癌腹膜播散引起的MBO患者中，姑息性手术在改善固体食物摄入的同时并未改善生活质量，术后发病率和死亡率在可接受的范围内。