Clinical significance of gastric outlet obstruction on the oncologic and surgical outcomes of radical surgery for carcinoma of the distal stomach

Background and Objectives: To determine the significance of gastric outlet obstruction (GOO) on the outcomes of radical surgery for distal gastric cancer. Methods: Three hundred seventy-one patients who underwent radical surgery for advanced gastric cancer arising at the distal stomach were categorized into two groups according to the presence of GOO, that is, 59 patients with GOO and 312 patients without. Clinicopathologic variables, postoperative morbidity and mortality, recurrence pattern, and survival outcomes of the two groups were compared. Results: Distal gastric carcinoma with GOO was usually diagnosed at a more advanced stage with aggressive pathologic features. GOO adversely affected overall survival after radical surgery with an odds ratio of 2.068 (P < 0.001). In patients with recurrent diseases, patients with GOO had higher rate of locoregional recurrence after radical surgery (P = 0.021). High-grade postoperative complications occurred at similar rates in both groups (P = 0.539). Conclusions: The presence of GOO is an independent prognostic factor after radical surgery for advanced distal gastric cancer and provide additional information for identifying patients at higher risk of recurrence and pattern of recurrence during follow-up. Radical surgery in patients with GOO can be performed with acceptable morbidity and mortality.