Abstract
Background and study aims Management of malignant gastrointestinal obstruction (MGIO) is more challenging in
the presence of peritoneal carcinomatosis (PC). Outcomes data to guide the management
of MGIO with PC are lacking. We aimed to compare the clinical outcomes and adverse
events between endoscopic and surgical palliation and identify predictors of stent
success in patients with MGIO with PC.
Patients and methods Consecutive inpatients with MGIO with PC between 2000 and 2018 who underwent palliative
surgery or enteral stenting were included. Clinical success was defined as relief
of obstructive symptoms.
Results Fifty-seven patients with enteral stenting and 40 with palliative surgery were compared.
The two groups did not differ in rates of technical success, 30-day mortality, or
recurrence. Clinical success from a single intervention (63.2 % versus 95 %), luminal
patency duration (27 days vs. 145 days), and survival length (148 days vs. 336 days)
favored palliative surgery (all P < 0.05) but the patients in the surgery group had a trend toward better Eastern Cooperative
Oncology Group (ECOG) status. The rate of adverse events (AEs) (10.5 % vs. 50 %),
the severity of AEs, and length of hospital stay (4.5 days vs. 9 days) favored enteral
stenting (P < 0.05). The need for more than one stent was associated with a higher likelihood
of stent failure.
Conclusions Our study suggests that enteral stenting is safer and associated with a shorter hospital
stay than palliative surgery, although unlike other MGIOs, clinical success is lower
in MGIO with PC. Identification of the right candidates and potential predictors of
clinical success in ECOG-matched large-scale studies is needed to validate these results.
