The clinical effects of laparoscopic gastrojejunostomy versus nasointestinal tube insertion with subsequent chemotherapy for uncurable gastric cancer patients with outlet obstruction

Objective To compare the clinical outcomes of laparoscopic gastrojejunostomy (LGJ) versus nasointestinal tube (NIT) insertion, both combined with chemotherapy, in patients with advanced gastric cancer and gastric outlet obstruction (GOO), and to provide evidence for optimal management strategies. Methods This retrospective study included 63 patients with incurable advanced gastric cancer and GOO treated at Fujian Provincial Hospital, between January 2019 and December 2022. Patients were assigned to either the LGJ group (n=33) or the NIT group (n=30). Clinical baseline data, short-term complications, quality of life (QOL), nutritional and inflammatory markers, chemotherapy response, and conversion surgery outcomes were compared. Prognostic factors for overall survival (OS) were evaluated using univariate and multivariate Cox regression analyses. Results Baseline characteristics were comparable between groups. No severe complications occurred in the LGJ group. Post-obstruction, LGJ significantly improved GOOSS scores, with 90.9% of patients resuming full oral intake, compared to 30% unable to eat in the NIT group. The LGJ group had longer hospital stays and delayed chemotherapy initiation but showed lower rates of elevated NLR and CEA (P<0.05). QOL declined more frequently in the NIT group (P<0.05). No significant differences were observed in chemotherapy response, conversion surgery rates (30.3% vs 23.3%), or pathological outcomes. Median OS was 18.3 months in the LGJ group vs 14.3 months in the NIT group (P = 0.453). Borrmann classification and conversion surgery were independent prognostic factors for OS. Conclusion LGJ offers superior improvement in nutritional status and QOL compared to NIT, with comparable survival outcomes. Borrmann type and conversion surgery are key predictors of long-term prognosis in this patient population.