Abstract

Background: Palliative surgical management of advanced gastric cancer with gastric outlet obstruction remains controversial. While both palliative gastrectomy (PG) and gastrojejunostomy (PGJ) offer symptom relief, their impact on survival and postoperative outcomes is debated.

Methods: We conducted a retrospective cohort study of 70 patients with advanced gastric cancer and symptomatic gastric outlet obstruction, treated at a single tertiary center between 2017 and 2024. Patients underwent either PG or PGJ after being deemed unsuitable for endoscopic intervention. Clinical and surgical parameters, complications, nutritional support, and survival outcomes were analyzed.

Results: Of the 70 patients, 46 underwent PG and 24 underwent PGJ. Median survival was significantly longer in the PG group (344 vs. 117 days, P<0.001), and PG was an independent predictor of improved survival (HR 0.083, P<0.001). PG was associated with higher rates of anastomotic leaks and ICU admissions, while PGJ showed higher rates of delayed gastric emptying and need for post-discharge nutritional support (33.3% vs. 6.7%, P=0.009). Return to oral intake was more common after PG (95.7% vs. 79.2%, P=0.042). Postoperative chemotherapy significantly improved survival (HR=0.152, P=0.003).

Conclusions: PG offers a significant survival benefit over PGJ in selected patients with advanced gastric cancer, but at the cost of increased surgical morbidity. Careful patient selection based on disease extent, performance status, and likelihood of postoperative recovery is essential for optimizing outcomes.