Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum.

BACKGROUND: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum. METHODS: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected data included: age, gender, performance status (Karnofsky's score), body mass index, histopathology, clinical stage (TNM classification), technical and clinical success of the procedure, time to oral intake, in-hospital stay, reintervention rate, and complications related to the treatment and survival. RESULTS: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky's score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001) and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005). We did not find statistically significant differences with regards to long-term survival. CONCLUSIONS: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter in-hospital stay and lower rate of complications.

Prótesis metálicas autoexpandibles versus antrectomía en el tratamiento paliativo del adenocarcinoma obstructivo del antro gástrico / Self-expanding metal stents versus antrectomy for the palliative treatment of obstructive adenocarcinoma of the gastric antrum

Introducción: los pacientes con cáncer gástrico tienen un tumor irresecable hasta en el 40% de los casos. La obstrucción de salida gástrica ocasiona vómito, deshidratación y desnutrición. El objetivo de este estudio fue comparar las prótesis metálicas autoexpandibles con la antrectomia en el tratamiento paliativo del adenocarcinoma obstructivo del antro gástrico. Método: estudio restrospectivo en pacientes con adenocarcinoma obstructivo del antro gástrico. Los pacientes fueron divididos en dos grupos: grupo A) sujetos que fueron tratados mediante prótesis metálica autoexpandible y grupo B) aquellos que fueron tratados mediante antrectomía y gastroyeyunoanastomosis en Y de Roux. Las variables recogidas fueron: edad, género, índice de masa corporal, histopatología, estadio clínico (TNM), estado general (escala de Karnofsky), días de estancia intrahospitalaria, necesidad de re-intervención, complicaciones relacionada con el tratamiento y sobrevida. Resultados: fueron incluidos 39 pacientes, 21 hombres y 18 mujeres. Diecinueve pacientes correspondieron al grupo A y 20 al grupo B. No hubo diferencias estadísticamente significativas con respecto a la edad, índice de masa corporal, calificación de Karnofsky y estadio clínico. El éxito técnico y clínico fue similar en ambos grupos. Hubo diferencia estadísticamente significativa entre ambos grupos, favoreciendo a las prótesis metálicas autoexpandibles en tiempo de inicio de la vía oral (1 ± 0 vs. 4,9 ± 0,6 días, p = 0,0001) y estancia intrahospitalaria (0,94 ± 1,18 vs. 7,8 ± 7,7 días, p = 0,0005). No encontramos diferencia estadísticamente significativa con respecto a la sobrevida entre los dos grupos. Conclusiones: en pacientes con obstrucción gástrica secundaria a cáncer gástrico avanzado, el tratamiento con prótesis metálicas autoexpandibles proporciona un intervalo mas corto para el inicio de la vía oral, una estancia intrahospitalaria mas corta y una frecuencia de complicaciones menor(AU)

Background: gastric cancer patients are first diagnosed with an unresectable tumor in up to 40% of cases. Gastric outlet obstruction causes nausea, vomiting, dehydration and malnutrition. The aim of the study was to compare self-expanding metal stents to antrectomy and Roux-en Y gastrojejunostomy for palliation of obstructive adenocarcinoma of the gastric antrum. Methods: retrospective study in patients with obstructing cancer of the gastric antrum. Patients were divided into two groups: group A, underwent endoscopic placement of self-expanding metal stents and group B underwent surgical treatment with antrectomy and Roux-en Y gastrojejunostomy. Collected Data included: age, gender, performance status (Karnofsky’s score), body mass index, histopathology, clinical stage (TNM classification), technical and clinical success of the procedure, time to oral intake, in-hospital stay, reintervention rate, and complications related to the treatment and survival. Results: a total of 39 patients with gastric adenocarcinoma were included, 21 male and 18 female. Nineteen patients were assigned to group A and 20 patients to group B. There were no statistically significant differences between groups in regards to age, body mass index, Karnofsky’s score and clinical stage. The technical and clinical success was similar for both groups. There was a statistically significant difference between groups favoring Self-expanding metal stent in time to oral intake (1 ± 0 vs. 4.9 ± 0.6 days, p = 0.0001) and in-hospital stay (0.94 ± 1.18 vs. 7.8 ± 7.7 days, p = 0.0005). We did not find statistically significant differences with regards to long-term survival. Conclusions: in patients with malignant gastric outlet obstruction due to gastric cancer, endoscopic palliation with self-expanding metal stents provide a shorter interval to oral intake, shorter inhospital stay and lower rate of complications(AU)

Argon plasma coagulation and hyperbaric oxygen therapy in chronic radiation proctopathy, effectiveness and impact on tissue toxicity.

BACKGROUND: chronic radiation proctopathy (CRP) is associated with recurrent rectal bleeding and transfusional requirements. Argon plasma coagulation (APC) and hyperbaric oxygen therapy (HOT) have been shown to be effective in the control of CRP. No prospective comparisons have been reported between these treatments. AIM: the aim was to evaluate the effectiveness, safety and impact on tissue toxicity of APC compared to HOT in patients with CRP. MATERIAL AND METHODS: a prospective study for evaluating treatment response was conducted. Patients with cervical cancer and CRP with rectal bleeding were recruited. They had not received previous treatment. Collected data included: demographics, previous radiation dosage, duration and severity of rectal bleeding. Hemoglobin, transfusional requirements, and tissue toxicity (SOMA LENT questionnaire) at baseline and at 1, 2, and 3 months follow up were recorded. RESULTS: thirty-one patients were included, 14 in the APC group and 17 in the HOT group. No response was noted in 13 and 18% of patients in the APC and HOT group respectively (p = NS). At the 1 and 2 months follow-up, the APC group showed a significantly better response in terms of transfusional requirements (0.6 vs. 3.4 and 0.7 vs. 2.5) and tissue toxicity score (5.3 vs. 8.6 and 3.8 vs. 7.248). After 3 months, both groups showed further improvement in all parameters without significant differences between them. CONCLUSIONS: APC and HOT were effective, safe and decreased the tissue toxicity scores in patients with CRP. However, response rate was higher and faster in the APC group.

Argón plasma y oxígeno hiperbárico para el control de la rectorragia crónica secundaria a la proctopatía por radiación / Argon plasma coagulation and hyperbaric oxygen therapy in chronic radiation proctopathy, effectiveness and impact on tissue toxicity

Introducción: la proctopatía por radiación (PPR) se asocia con rectorragía recurrente y requerimientos de trasfusiones. La coagulación con argón plasma (APC) y la terapia con oxígeno hiperbárico (HOT) han sido efectivas en el control de la PPR. No hay estudios prospectivos comparativos entre ambas técnicas. Objetivo: el objetivo del estudio es evaluar la efectividad, seguridad y el impacto en la toxicidad tisular de la APC comparado con el HOT en los pacientes con PR. Material y métodos: se realizó un estudio prospectivo para evaluar la respuesta al tratamiento. Se incluyeron a pacientes con cáncer cervicouterino y PPR con rectorragia recurrente, sin haber recibido tratamientos previos. Se tomaron datos demográficos, dosis de radiación, duración y severidad de la rectorragia, niveles de hemoglobina, requerimientos de trasfusiones y la toxicidad tisular (Cuestionario de SOMA-LENT) al inicio, y a los 1, 2 y 3 meses del tratamiento. Resultados: se incluyeron a 31 pacientes con PPR, 14 en el grupo de APC y 17 en el grupo de HOT. No hubo respuesta en el 13 y 18% de los pacientes en el grupo de APC y OHT respectivamente (p = NS). Al primer y segundo mes de seguimiento, el grupo APC mostró una mejoría significativa en los parámetros de requerimientos trasfusionales (0,6 vs. 3,4 y 0,7 vs. 2,5) y en la toxicidad tisular (5,3 vs. 8,6 y 3,8 vs. 7,2). Después de 3 meses de seguimiento, ambos grupos mostraron mejoría en todos los parámetros sin haber diferencias estadísticamente significativas. Conclusiones: APC y HOT fueron efectivos, seguros y disminuyeron la toxicidad tisular en los pacientes con PPR. Sin embargo la respuesta fue más efectiva y rápida en el grupo del APC(AU)

Background: chronic radiation proctopathy (CRP) is associated with recurrent rectal bleeding and transfusional requirements. Argon plasma coagulation (APC) and hyperbaric oxygen therapy (HOT) have been shown to be effective in the control of CRP. No prospective comparisons have been reported between these treatments. Aim: the aim was to evaluate the effectiveness, safety and impact on tissue toxicity of APC compared to HOT in patients with CRP. Material and methods: a prospective study for evaluating treatment response was conducted. Patients with cervical cancer and CRP with rectal bleeding were recruited. They had not received previous treatment. Collected data included: demographics, previous radiation dosage, duration and severity of rectal bleeding. Hemoglobin, transfusional requirements, and tissue toxicity (SOMA LENT questionnaire) at baseline and at 1, 2, and 3 months follow up were recorded. Results: thirty-one patients were included, 14 in the APC group and 17 in the HOT group. No response was noted in 13 and 18% of patients in the APC and HOT group respectively (p = NS). At the 1 and 2 months follow-up, the APC group showed a significantly better response in terms of transfusional requirements (0.6 vs. 3.4 and 0.7 vs. 2.5) and tissue toxicity score (5.3 vs. 8.6 and 3.8 vs. 7.248). After 3 months, both groups showed further improvement in all parameters without significant differences between them. Conclusions: APC and HOT were effective, safe and decreased the tissue toxicity scores in patients with CRP. However, response rate was higher and faster in the APC group(AU)