Predictors of survival in patients with malignant gastric outlet obstruction: A patient-oriented decision approach for palliative treatment

SM (Suzanne) Jeurnink, Ewout Steyerberg, FP Vleggaar, Casper van Eijck, JE van Hooft, MP Schwartz, Ernst Kuipers, PD (Peter) Siersema

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Abstract

Background: Gastrojejunostomy and stentplacement are the most commonly used treatments for malignant gastric outlet obstruction (GOO). The preference for either treatment largely depends on the expected survival. Our objective was to investigate predictors of survival in patients with malignant GOO and to develop a model that could aid in the decision for either gastrojejunostomy or stentplacement. Methods: Prognostic factors for survival were collected from a literature search and evaluated in our patient population, which included 95 retrospectively and 56 prospectively followed cases. All 151 patients were treated with gastrojejunostomy or stentplacement. Results: A higher WHO performance score was the only significant prognostic factor for survival in our multivariable analysis (HR 2.2 95%CI 1.7-2.9), whereas treatment for obstructive jaundice, gender, age, metastases, weight loss, level of obstruction and pancreatic cancer were not. A prognostic model that includes the WHO score was able to distinguish patients with a poor survival (WHO score 3-4, median survival: 31 days) from those with a relatively intermediate or good survival (WHO score 2, median survival: 69 and WHO score 0-1, median survival: 139 days, respectively). Conclusions: Only the WHO score is a significant predictor of survival in patients with malignant GOO. A simple prognostic model is able to guide the palliative treatment decision for either gastrojejunostomy (WHO score 0-1) or stentplacement (WHO 3-4) in patients with malignant GOO. (C) 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)548-552
Number of pages5
JournalDigestive and Liver Disease
Volume43
Issue number7
DOIs
Publication statusPublished - 2011

Research programs

  • EMC MM-03-47-02-A
  • EMC MM-03-47-11
  • EMC MM-04-20-01
  • EMC NIHES-02-65-01

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