Palliative Gastroenterostomy in Malignant Gastric Outlet Obstruction: A Single-Center, Single Surgical Team Experience

Yıl 2025, Cilt: 6 Sayı: 3, 258 - 265, 28.09.2025

Feyyaz Güngör , Hüseyin Kılavuz , Birkan Bozkurt , Murat Demir , Muhammed Furkan Arslan , İdris Kurtuluş

https://doi.org/10.47482/acmr.1645120

Öz

Background: Malignant gastric outlet obstruction (GOO) is a common complication of stomach, pancreas, and periampullary region tumors, causing serious nutritional disorders and loss of quality of life. This study evaluated the clinical data and factors affecting the survival of patients who underwent palliative gastroenterostomy.
Methods: Data from 23 patients who underwent palliative gastroenterostomy due to malignant gastric outlet obstruction in our center between June 2020 and January 2025 were analyzed retrospectively. Demographic characteristics, preoperative clinical data, intraoperative findings, and postoperative outcomes of the patients were evaluated. Patients were divided into two groups according to their survival times as below and above 90 days; factors affecting survival were analyzed by Kaplan-Meier curves and Cox regression analyses.
Results: Patients who lived longer than 90 days had higher Karnofsky Performance Score, lower Charlson Comorbidity Index, higher albumin level, and preserved electrolyte balance (p<0.05). In multivariate analysis, only Clavien-Dindo Classification ≥3a level complications (HR: 60.77; p=0.002) and high Gastric Outlet Obstruction Scoring System (GOOSS) score (HR: 0.01; p=0.008) were identified as factors independently affecting survival.
Conclusions: Preoperative oral intake capacity and postoperative major complications are the main determinants that directly affect survival. Parameters such as functional status, comorbidity burden, and metabolic balance should also be taken into account in terms of prognosis. Detection of malignancies before GOO occurs and effective management of complications with a multidisciplinary approach may improve patient outcomes.

Anahtar Kelimeler

Malignant gastric outlet obstruction , palliative gastroenterostomy , survival , nutrition , complications

Malign Gastrik Outlet Obstrüksiyonunda Palyatif Gastroenterostomi: Tek Merkezli, Tek Cerrahi Ekip Deneyimi

Öz

Giriş: Malign gastrik outlet obstrüksiyonu (GOO), mide, pankreas ve periampüller bölge tümörlerinin sık görülen bir komplikasyonu olup, ciddi beslenme bozuklukları ve yaşam kalitesi kaybına yol açmaktadır. Bu çalışmada, palyatif gastroenterostomi uygulanan hastaların klinik verileri ve sağkalımı etkileyen faktörler değerlendirildi.
Method: Haziran 2020 - Ocak 2025 tarihleri arasında merkezimizdeki malign GOO nedeniyle palyatif gastroenterostomi uygulanan 23 hastanın retrospektif verileri analiz edildi. Hastaların yaş, cinsiyet, Karnofsky Performans Skoru (KPS), Eastern Cooperative Oncology Group (ECOG) skoru, Charlson Komorbidite İndeksi (CCI), Amerikan Anesteziyoloji Derneği (ASA) skoru, vücut kitle indeksi (BMI), preoperatif albümin düzeyi, elektrolit dengesizliği, beslenme desteği varlığı ve türü, malignite tipi, gastrik çıkış obstrüksiyon skoru (GOOSS), ek cerrahi prosedür uygulanıp uygulanmadığı ve Clavien-Dindo komplikasyon sınıflandırması parametreleri incelendi. Sağkalım süresi 90 günden uzun ve kısa olan hastalar karşılaştırıldı.
Bulgular: Daha yüksek KPS (p=0,04), düşük CCI skoru (p=0,011), yüksek preoperatif albümin düzeyi (p=0,026) ve elektrolit dengesinin korunması (p=0,005), uzun sağkalım ile ilişkili bulundu. Ciddi postoperatif komplikasyonlar sağkalımı olumsuz etkiledi (p=0,006). Yaş, cinsiyet, ASA skoru, BMI, beslenme desteği türü, malignite tipi, GOOSS skoru ve ek cerrahi prosedür açısından sağkalım grupları arasında anlamlı fark bulunmadı (p>0,05).
Sonuç: Preoperatif fonksiyonel durum, beslenme durumu ve elektrolit dengesi, sağkalımı belirleyen temel faktörlerdir. Cerrahi sonrası komplikasyonların azaltılması, optimal beslenme desteği sağlanması ve multidisipliner hasta yönetimi, prognozu iyileştirmek için kritik önem taşımaktadır.

Anahtar Kelimeler

Malign gastrik outlet obstrüksiyonu , palyatif gastroenterostomi , sağkalım , beslenme , komplikasyon

Kaynakça

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