To investigate the clinical feasibility and postoperative outcomes of the laparoscopic modified Devine procedure for patients with advanced gastric cancer complicated by pyloric obstruction.

A retrospective analysis was performed on the clinical data of 35 patients with advanced gastric cancer complicated with pyloric obstruction admitted to the Gastrointestinal Center of Northern Jiangsu People’s Hospital Affiliated to Yangzhou University from March 2017 to March 2022. Among them, 15 patients underwent laparoscopic modified Devine procedure (LGP group) and 20 underwent traditional gastrojejunostomy (CGJ group). Postoperative follow-up continued until March 2025. The postoperative complications, nutritional status, and satisfaction rate between the two groups were analyzed. Univariate analysis and Cox proportional hazards regression models were performed to identify independent factors affecting patient survival. Survival data were analyzed using Kaplan-Meier curves and the Log-rank test.

A 1-month postoperative complication analysis showed that the incidences of gastric emptying disorder, tumor bleeding, and anastomotic recurrence were lower in the LGP group compared to those in the CGJ group (1/15 vs 5/20, 0/15 vs 1/20, 0/15 vs 1/20), although the differences were not statistically significant. 3 months postoperatively, the decrease values of hemoglobin, total protein, and body weight in the LGP group were all lower than those in the CGJ group, but the differences were not statistically significant. The patient satisfaction was significantly higher in the LGP group compared to the CGJ group (93.33% vs 50.00%, P=0.005). Survival analysis showed that the median survival time for the LGP group was 11 months, which was significantly longer than 6 months for the CGJ group (Log-rank χ²=9.823, P=0.002). Multivariate Cox regression analysis identified surgical method (HR=0.226, 95% CI: 0.087-0.590, P=0.002) and distant metastasis (HR=6.907, 95% CI: 2.640-18.069, P<0.001) as independent factors affecting survival time.

Laparoscopic modified Devine procedure is safe and feasible for patients with advanced gastric cancer complicated by pyloric obstruction, which effectively alleviates symptoms, improves postoperative nutritional status and quality of life, prolongs survival time, and achieves high levels of patient satisfaction, making it worthy of clinical promotion.