[Outcomes after Gastrojejunostomy for Unresectable Gastric Cancer(Including Two Cases of Conversion Surgery) - A Retrospective Study].

BACKGROUND: Gastrojejunostomy as palliative surgery has been thought to contribute towards resumption of food intake and improvement of the patient's quality of life. This study aimed to examine the effect of gastrojejunostomy for unresectable gastric cancer on mortality and postoperative course. METHODS: We retrospectively examined the records of 34 patients who underwent gastrojejunostomy for unresectable gastric cancer in our hospital from April 2008 to November 2015. Characteristics of the patients and operations, postoperative courses, and overall survival were assessed. The Kaplan-Meier method and loglank test were used for the survival analysis. RESULTS: The median overall survival was 310 days(95%CI: 136-485), and 1 year overall survival rate was 45%(95%CI: 27.5-61.1)in 34 patients who underwent gastrojejunostomy. Liver metastasis was associated with a lower survival rate, and chemotherapy after gastrojejunostomy was associated with a significantly higher survival rate. Two of 34 patients(5.9%)underwent conversion surgery after effective chemotherapy. CONCLUSION: Gastrojejunostomy for unresectable gastric cancer may have the potential to contribute towards not only an improvement in the patient's quality of life with regard to the resumption of food intake, but also prolongation of the overall survival with chemotherapy and conversion surgery.

Delayed perforation occurring on the 24th day after endoscopic submucosal dissection for early gastric cancer.

Delayed perforation occurs after 0.5% of endoscopic submucosal dissection (ESD) procedures for early gastric cancer (EGC). This complication can occur within a few hours or days after ESD. There are few reports in the English literature concerning patients who developed delayed perforation after ESD for EGC. An 81-year-old woman was referred to the emergency department of our hospital on the 24th day after ESD because of abdominal pain. We diagnosed her with delayed perforation with peritonitis after ESD for EGC using computed tomography (CT) and esophagogastroduodenoscopy (EGD). We performed primary closure with interrupted sutures covered via pedicled omentoplasty. The patient was discharged 13 days after surgery without any postoperative complications. Delayed perforation is generally treated with conservative, surgical, or endoscopic methods. Several benefits of endoscopic clipping have been reported. However, in the present case, we performed emergency surgery while considering possible fatal complications, such as severe peritonitis. It is important to recognize delayed perforation in the differential diagnosis. The decision to perform surgery should be made after carefully considering the degree of perforation based on EGD, CT findings, and patient conditions.