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Curative-intent treatment for distal gastric cancer with gastric outlet obstruction : Management pathways and clinical outcomes from a Swedish multicenter cohort

Zeyara, Adam LU orcid ; Scarfone, Léonie LU ; Hermez Chole, Martina ; Falkenback, Dan LU ; Tingstedt, Bobby LU ; Johansson, Jan LU orcid and Rouvelas, Ioannis (2026) In Surgical Oncology 66.
Abstract

BACKGROUND: Distal gastric cancer with gastric outlet obstruction (GOO) poses challenges to multimodal treatment. The optimal management strategy in patients undergoing curative-intent treatment remains unclear. This study aimed to characterize real-world management pathways and outcomes in patients with distal gastric cancer presenting with clinically significant GOO.

METHODS: All consecutive patients undergoing curative-intent resection for distal gastric adenocarcinoma with GOO between 2006 and 2024 at two Swedish tertiary centers were identified from national registry and institutional databases with chart validation. Patients were categorized according to treatment strategy: neoadjuvant chemotherapy or up-front surgery.... (More)

BACKGROUND: Distal gastric cancer with gastric outlet obstruction (GOO) poses challenges to multimodal treatment. The optimal management strategy in patients undergoing curative-intent treatment remains unclear. This study aimed to characterize real-world management pathways and outcomes in patients with distal gastric cancer presenting with clinically significant GOO.

METHODS: All consecutive patients undergoing curative-intent resection for distal gastric adenocarcinoma with GOO between 2006 and 2024 at two Swedish tertiary centers were identified from national registry and institutional databases with chart validation. Patients were categorized according to treatment strategy: neoadjuvant chemotherapy or up-front surgery. Primary outcome was overall survival. Survival was analyzed using Kaplan-Meier estimates and multivariable Cox regression adjusting for age, ASA class, clinical T stage and nodal status.

RESULTS: A total of 103 patients were included; 36 (35.0%) received neoadjuvant chemotherapy and 67 (65.0%) underwent up-front surgery. Patients receiving neoadjuvant therapy were younger (median 63.7 vs 77 years, p < 0.001) and more frequently had cT3-4 and cN + disease (p < 0.001). Most patients completed planned neoadjuvant treatment. R1 resection rates were high and comparable between groups (30.6% vs 28.4%, p = 0.75). Median overall survival was 19.6 months after neoadjuvant therapy and 19.2 months after up-front surgery (log-rank p = 0.38). On multivariable analysis, treatment strategy was not independently associated with overall survival (HR 0.86, 95% CI 0.47-1.57; p = 0.63).

CONCLUSION: GOO in distal gastric cancer should not be considered an absolute contraindication to neoadjuvant therapy when adequate nutritional and supportive strategies are employed. However, feasibility does not equal justification - in the absence of a survival benefit and in the context of increased severe postoperative complications, treatment decisions should be individualized through careful multidisciplinary assessment until better powered prospective studies are performed.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Stomach Neoplasms/pathology, Female, Gastric Outlet Obstruction/pathology, Sweden/epidemiology, Male, Survival Rate, Aged, Adenocarcinoma/pathology, Neoadjuvant Therapy/mortality, Gastrectomy/mortality, Middle Aged, Prognosis, Follow-Up Studies, Retrospective Studies
in
Surgical Oncology
volume
66
article number
102449
publisher
Elsevier
external identifiers
  • scopus:105039265615
  • pmid:42166873
ISSN
0960-7404
DOI
10.1016/j.suronc.2026.102449
language
English
LU publication?
yes
additional info
Copyright © 2026 The Authors. Published by Elsevier Ltd.. All rights reserved.
id
2d435d24-cf84-4b76-9ab5-579d2c151777
date added to LUP
2026-08-24 08:47:09
date last changed
2026-10-07 03:51:15
@article{2d435d24-cf84-4b76-9ab5-579d2c151777,
  abstract     = {{<p>BACKGROUND: Distal gastric cancer with gastric outlet obstruction (GOO) poses challenges to multimodal treatment. The optimal management strategy in patients undergoing curative-intent treatment remains unclear. This study aimed to characterize real-world management pathways and outcomes in patients with distal gastric cancer presenting with clinically significant GOO.</p><p>METHODS: All consecutive patients undergoing curative-intent resection for distal gastric adenocarcinoma with GOO between 2006 and 2024 at two Swedish tertiary centers were identified from national registry and institutional databases with chart validation. Patients were categorized according to treatment strategy: neoadjuvant chemotherapy or up-front surgery. Primary outcome was overall survival. Survival was analyzed using Kaplan-Meier estimates and multivariable Cox regression adjusting for age, ASA class, clinical T stage and nodal status.</p><p>RESULTS: A total of 103 patients were included; 36 (35.0%) received neoadjuvant chemotherapy and 67 (65.0%) underwent up-front surgery. Patients receiving neoadjuvant therapy were younger (median 63.7 vs 77 years, p &lt; 0.001) and more frequently had cT3-4 and cN + disease (p &lt; 0.001). Most patients completed planned neoadjuvant treatment. R1 resection rates were high and comparable between groups (30.6% vs 28.4%, p = 0.75). Median overall survival was 19.6 months after neoadjuvant therapy and 19.2 months after up-front surgery (log-rank p = 0.38). On multivariable analysis, treatment strategy was not independently associated with overall survival (HR 0.86, 95% CI 0.47-1.57; p = 0.63).</p><p>CONCLUSION: GOO in distal gastric cancer should not be considered an absolute contraindication to neoadjuvant therapy when adequate nutritional and supportive strategies are employed. However, feasibility does not equal justification - in the absence of a survival benefit and in the context of increased severe postoperative complications, treatment decisions should be individualized through careful multidisciplinary assessment until better powered prospective studies are performed.</p>}},
  author       = {{Zeyara, Adam and Scarfone, Léonie and Hermez Chole, Martina and Falkenback, Dan and Tingstedt, Bobby and Johansson, Jan and Rouvelas, Ioannis}},
  issn         = {{0960-7404}},
  keywords     = {{Humans; Stomach Neoplasms/pathology; Female; Gastric Outlet Obstruction/pathology; Sweden/epidemiology; Male; Survival Rate; Aged; Adenocarcinoma/pathology; Neoadjuvant Therapy/mortality; Gastrectomy/mortality; Middle Aged; Prognosis; Follow-Up Studies; Retrospective Studies}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Surgical Oncology}},
  title        = {{Curative-intent treatment for distal gastric cancer with gastric outlet obstruction : Management pathways and clinical outcomes from a Swedish multicenter cohort}},
  url          = {{http://dx.doi.org/10.1016/j.suronc.2026.102449}},
  doi          = {{10.1016/j.suronc.2026.102449}},
  volume       = {{66}},
  year         = {{2026}},
}