Effectiveness and safety of chemotherapy for patients with malignant gastrointestinal obstruction: A Japanese population-based cohort study

Gota Fujisawa; Ryota Niikura; Takuya Kawahara; Tetsuro Honda; Kenkei Hasatani; Naohiro Yoshida; Tsutomu Nishida; Tetsuya Sumiyoshi; Shu Kiyotoki; Takashi Ikeya; Masahiro Arai; Yoku Hayakawa; Takashi Kawai; Mitsuhiro Fujishiro

doi:10.12998/wjcc.v10.i16.5253

Effectiveness and safety of chemotherapy for patients with malignant gastrointestinal obstruction: A Japanese population-based cohort study

World J Clin Cases. 2022 Jun 6;10(16):5253-5265. doi: 10.12998/wjcc.v10.i16.5253.

Authors

Affiliations

¹ Department of Gastroenterology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan.
² Gastroenterological Endoscopy, Tokyo Medical University, Tokyo 1600023, Japan. rniikura@triton.ocn.ne.jp.
³ Clinical Research Support Center, The University of Tokyo Hospital, Tokyo 1138655, Japan.
⁴ Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 8508555, Japan.
⁵ Department of Gastroenterology, Fukui Prefectural Hospital, Fukui 9108526, Japan.
⁶ Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 9208530, Japan.
⁷ Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 5608565, Japan.
⁸ Department of Gastroenterology, Tonan Hospital, Hokkaido 0600004, Japan.
⁹ Department of Gastroenterology, Shuto General Hospital, Yamaguchi 7420032, Japan.
¹⁰ Department of Gastroenterology, St. Luke's International Hospital, Tokyo 1048560, Japan.
¹¹ Department of Gastroenterology, Nerima Hikarigaoka Hospital, Tokyo 1790072, Japan.
¹² Gastroenterological Endoscopy, Tokyo Medical University, Tokyo 1600023, Japan.

Abstract

Background: The impacts of chemotherapy on patients with malignant gastrointestinal obstructions remain unclear, and multicenter evidence is lacking.

Aim: To evaluate the effectiveness and safety of chemotherapy in patients with unresectable malignant gastrointestinal obstructions.

Methods: We conducted a multicenter retrospective cohort study that compared the chemotherapy group who received any chemotherapeutics after interventions, including palliative surgery or self-expandable metal stent placement, for unresectable malignant gastrointestinal obstruction vs the best supportive care (BSC) group between 2014 and 2019 in nine hospitals. The primary outcome was overall survival, and the secondary outcomes were patency duration and adverse events, including gastrointestinal perforation and gastrointestinal bleeding.

Results: In total, 470 patients in the chemotherapy group and 652 patients in the BSC group were analyzed. During the follow-up period of 54.1 mo, the median overall survival durations were 19.3 mo in the chemotherapy group and 5.4 mo in the BSC group (log-rank test, P < 0.01). The median patency durations were 9.7 mo [95% confidence interval (CI): 7.7-11.5 mo] in the chemotherapy group and 2.5 mo (95%CI: 2.0-2.9 mo) in the BSC group (log-rank test, P < 0.01). The perforation rate was 1.3% (6/470) in the chemotherapy group and 0.9% (6/652) in the BSC group (P = 0.567). The gastrointestinal bleeding rate was 1.5% (7/470) in the chemotherapy group and 0.5% (3/652) in the BSC group (P = 0.105).

Conclusion: Chemotherapy after interventions for unresectable malignant gastrointestinal obstruction was associated with increased overall survival and patency duration.

Keywords: Chemotherapy; Gastrointestinal cancer; Malignant gastrointestinal obstruction; Palliative surgery; Self-expandable metal stent.