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Invited Critique
July 1, 2007

Stomach-Partitioning Gastrojejunostomy for Gastroduodenal Outlet Obstruction—Invited Critique

Arch Surg. 2007;142(7):611. doi:10.1001/archsurg.142.7.611

Kubota et al offer an alternative procedure for the relief of the vexing problem of malignant GOO in patients with tumors that are not resectable. While their procedure (SPGJ) may be a useful addition to available options, the suggestion that this is a fair comparison with endoscopic stenting is misleading. In the study by Kubota et al, Figure 3 reveals that 81% of patients in both groups were dead at 1-year follow-up. However, the median survival in the stent group was only 2.8 months (compared with 7.3 months in the SPGJ group). The patients in the stent group weighed a mean of 10 kg less than those in the SPGJ group. Finally, almost half of the stent group had advanced pancreatic or ovarian cancer. These facts strongly suggest that the patients in the stent group were more ill or had more advanced malignant neoplasms. This may well represent proper patient selection, but it precludes an “apples to apples” comparison.

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