ABSTRACT
BACKGROUND: Few studies have focused on palliative surgery in patients with advanced gastroesophageal junction (GEJ) or gastric cancer. We sought to evaluate clinical observational outcomes following palliative surgery in this population. PATIENTS AND METHODS: Patients with GEJ or gastric cancer who underwent palliative surgery (1/2010-11/2022) were identified. The primary outcomes were symptom improvement, ability to tolerate an oral diet, discharge to home, 30 "good days" without hospitalization, and receipt of systemic treatment. Postoperative outcomes and survival were secondarily evaluated. RESULTS: Among 93 patients, the median age was 59 (IQR 47-68) years, and the median Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was 1 (range 0-3). The most frequent indication for palliative surgery was primary tumor obstruction [75 (81%) patients]. The most common procedures were feeding tube placement in 60 (65%) and intestinal bypass in 15 (16%) patients. A total of 75 (81%) patients experienced symptom improvement. Of these, 19 (25%) developed recurrent and 49 (65%) developed new symptoms. ECOG-PS was significantly associated with symptom-free time. Among those who underwent a bypass, resection, or ostomy creation for malignant obstruction, 16 (80%) tolerated an oral diet. Postoperatively, 87 (94%) were discharged home, 72 (77%) had 30 good days, and 64 (69%) received systemic treatment. Postoperative complications occurred in 35 (38%) patients, and 7 (8%) died within 30 days. The median survival time was 7.7 (95% CI 6.4-10.40) months. CONCLUSIONS: Patients with incurable GEJ or gastric cancer can benefit from palliative surgery. Prognosis and performance status should inform goals-of-care discussions and patient selection for surgical palliation.
Subject(s)
Esophageal Neoplasms , Esophagogastric Junction , Palliative Care , Stomach Neoplasms , Humans , Esophagogastric Junction/pathology , Esophagogastric Junction/surgery , Male , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Middle Aged , Female , Palliative Care/methods , Aged , Survival Rate , Esophageal Neoplasms/surgery , Esophageal Neoplasms/pathology , Esophageal Neoplasms/mortality , Prognosis , Follow-Up Studies , Retrospective Studies , Postoperative Complications , Gastrectomy/mortalitySubject(s)
Esophageal Neoplasms , Esophagogastric Junction , Palliative Care , Stomach Neoplasms , Humans , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Palliative Care/methods , Esophagogastric Junction/pathology , Esophagogastric Junction/surgery , Esophageal Neoplasms/surgery , Esophageal Neoplasms/pathology , Prognosis , Survival Rate , Observational Studies as TopicABSTRACT
Scaphoid nonunion occurs in 10%-15% of scaphoid fractures, potentially resulting in scaphoid nonunion advanced collapse. Distal scaphoid excision without allograft interposition is a known treatment, but can result in loss of carpal height and pain. This report describes the application of human acellular dermal matrix as an interposition graft after distal scaphoid excision for stage I scaphoid nonunion advanced collapse. Postoperatively, the patient initiated early range of motion and returned to full activity at 6 weeks. He demonstrated resolution of his pain 6 years later.