Palliative surgical treatment for enterostasis caused by recurrent gastric cancer: analysis of survival and QOL based on pathological features.

摘要

To improve quality of life (QOL) and prolong survival, enterostasis caused by recurrent gastric cancer must be treated appropriately. We reviewed the current treatment retrospectively. The subjects were 43 patients with enterostasis caused by recurrent gastric cancer and treated by surgical procedures at our hospital from 1988 to 1997. Survival and QOL were analyzed in relation to the mode of recurrence, the pathological diagnosis at the initial operation, and surgical procedures. The patients treated by colostomy, ileostomy, or bypass for local occlusion caused by isolated peritoneal recurrence or lymph node recurrence had significantly better quality of life and longer survival [discharge rate: colostomy and ileostomy, 81.8% (9/11); bypass, 77.8% (14/18); survival time: colostomy and ileostomy, 223.5 +/- 171.9 days; bypass, 129.6 +/- 91.0 days] than those who underwent exploratory laparotomy, gastrostomy, or enterostomy and had diffuse disseminated lesions of peritoneal recurrence [discharge rate: 21.4% (3/14); survival time: 44.6 +/- 31.5 days; P < 0.05]. In the patients in whom the pathological diagnosis at initial surgery was differentiated type or poorly solid type, the risk of exploratory laparotomy alone was low (5.6%; 1/18; P < 0.01). Enterostasis with pathological diagnosis at initial surgery of differentiated type or poorly solid type should be treated with aggressive laparotomy and colostomy, ileostomy, or bypass to improve survival and QOL.