The Effect Of Gastrointestinal Anastomosis Conbined With Postoperative Chemotherapy On Unresectable Advanced Gastric Cancer

Background:According to the literatures reported, the incidence of gastric carcinoma accounts for the fourth of all malignant tumor,but the fatality rate is in possession of second place,the five-year survival rate is only or less than 20%.Due to the absence of the early symptoms of gastric cancer,Therefore,to find it is relatively difficult.when it was diagnosed clinically,most of them have been advanced gastric carcinoma.Pyloric obstruction is a common complication of advanced gastric cancer,especially,when the lump is located in gastric antrum or pylorus area.With pyloric obstruction,patients are difficulty to eat food,so it cause patients thin and physical decline.When the disease is serious,albumin and ion in the blood are turbulence and than death.So far,the surgical operation is the first choice for advanced gastric carcinoma with pyloric obstruction.The second leg of lymph node radical cleaning(D2 Radical resection) has become the standard operation for gastric carcinoma.But for peritoneal metastasis,hepatic metastases,Serious local infiltration or distant metastases and so on,it is unable to resect the lump completely by surgery.However,the surgical treatment can improve the patient’s physical condition,if so,the surgery can provides a good foundation for postoperative radiotherapy, chemotherapy and other treatment.Gastrointestinal anastomosis is one of the commonly used surgical procedure.But to the advanced gastric cancer patients with pyloric obstruction,how the effect of postoperative in combination with chemotherapy has yet to clear report.So,we discussed this problems inthis parper.objective:To discuss the effect of Gastrointestinal anastomosis combined with postoperative chemotherapy for unresectable advanced gastric cancer with pyloric obstruction.Methods:Retrospective analysis the 37 cases of unresectable advanced gastric cancer with pyloric obstruction patients from Our hospital January 2012 to March 2015.The patients in the group either diagnose gastric carcinoma through pathology or highly suspected gastric carcinoma by abdominal imaging,and together with varying degrees of pyloric obstruction symptoms.Through useing gastroscope,abdominal ultrasound,abdominal computed tomography and so on to comprehensive analysis patient’s condition.After adjusting patient’s physical state gastrointestinal anastomosis were performed, every patient were given postoperative chemotherapy.Chemotherapy regimens: SOX regimen, after 3 cycles we use gastroscope, abdominal ultrasound or abdominal CT examination to test the effect of chemotherapy.Results:37 patients, After gastrointestinal anastomosis,all the GOOSS score,physical state, hemoglobin and serum albumin are improved than before.And through analyzing the time of Intraoperative anesthesia, blood loss,the time of pulling out stomach tube,the time of postoperative exhaust, the time of eat porridge, the time of free activities and the median length of hospital stay,we can come to the conclusion that if the patient’s survival expected is limited, the gastrointestinal anastomosis’ value is relative higher.The incidence of complications was 32.4%,and no operative deaths. After 3 cycles of chemotherapy,62.2% of patients getpartial response(PR), 29.7% of patients getstable disease(SD), the overall clinical response rate was 62.2%. After chemotherapy all patients have nausea, 67.6% of patients was vomiting, 75.7% of patients with white blood cells reduce, 35.1% of the patients with liver and kidney damage, 56.8% of patients with peripheral neuropathy.After treatment,17.1% of patients die in a half years;28.6% of the patients survive more than half year,45.7% of the patients survive more than 1year,and 8.6% of patients survive at least 2 years, the average survival period was 398.7±201.5 days.Conclusions:1.For unresection advanced gastric carcinoma with pyloric obstruction patients,gastrointestinal anastomosis combine postoperative chemotherapy can improve the patients’ nutritional state and improve the quality of life.2.For unresection advanced gastric carcinoma with pyloric obstruction patients,gastrointestinal anastomosis combine postoperative chemotherapy Can control the disease development and prolong survival period.3. For unresection advanced gastric carcinoma with pyloric obstruction patients,gastrointestinal anastomosis combine postoperative chemotherapy did not increase mortality and the complications can been controled.