Antral localization worsens the efficacy of enteral stents in malignant digestive tumors.

BACKGROUND AND AIMS: Malignant gastric outlet obstruction can be treated by means of enteral stenting or surgical gastrojejunalanatomosis. We evaluated in a prospective and multicentre study the efficacy of the enteral stent on food intake, the quality of life impact, and the relationship between efficacy and determined clinical and technical parameters. PATIENTS AND METHODS: Seventy one patients affected by symptoms arising from gastroduodenal obstruction due to malignant tumors, with criteria of irresecability, metastatic disease or very high surgical risk, were treated by means of self expanding metal stents. We used the GOOSS index to evaluate efficacy, and the Euro Qol-5D index to evaluate quality of life. RESULTS: Before stenting patients with GOOSS 0 and 1 were 68 (98.5%). After stenting patients with GOOSS 2 and 3 (semisolid and solid food) were 58 (84,1%) (P<.0001). The Euro Qol-5D index measured before and a month after stenting were 10.17 and 10.04 respectively (P=.6). The median survival was 91 days (9-552). The enteral stents for localised tumors in the duodenum and the gastrojejunalanastomosis were effective in 26 patients (70.2%) and 13 patients respectively (86.6%), while the enteral stents of tumors in the antrum were effective in only 5 patients (29.4%). CONCLUSIONS: The palliative treatment of malignant gastric outlet obstruction with a uncovered metal stent produces a significant improvement of oral food intake and maintains the overall quality of life index. The antral localization is associated with a lower efficacy of the procedure.

[Results of hepatobiliary and pancreatic surgery according to DRG in a level 2 hospital surgery department during the years 2005-2006]. / Resultados de la cirugía hepatobiliopancreática en un servicio de cirugía de un hospital de segundo nivel según los GRD durante el bienio 2005-2006.

OBJECTIVE: To assess the results of the hepatobiliary and pancreatic surgery of a surgery department during 2005-2006 using the diagnostic related groups. MATERIALS AND METHOD: The data were obtained from the CMBD-HA of the Catalan Health Service. We assessed the frequency, hospital stay and mortality of the surgical procedures. The results were compared with the 63 public hospitals, and the 8 of them belonging to the Catalan Health Institute. RESULTS: In our area, a clear trend is observed in referrals for certain types of complex procedures on the liver, pancreas and biliary system excluding cholecystectomy with or without associated morbidities (7-11%) without exceeding the population percentage (12%). In our centre, the impact on hospital stay is more evident in complex procedures. The total savings in our centre during the years 2005-2006 compared with the XHUP hospitals group were 2212 days of hospital stay with an equivalent cost saving of more than one million euro. The frequency and the results of hospital stay and mortality of laparoscopic and open cholecystectomy were those expected for the population covered by a general hospital. The mortality in complex procedures was half of that of the whole public network or the ICS centres. CONCLUSIONS: In the complex hepatobiliary-pancreatic pathology, the mortality, and cost savings in our centre appear to be the result of, not only the high volume of procedures, but also to specialisation and factors related to the structure of the department, and surgeon training.