Stomach-Partitioning Versus Conventional Gastrojejunostomy for Malignant Gastric Outlet Obstruction: A Multicenter Randomized Controlled Trial

Prior treatment

• Active autoimmune disease within 4 weeks prior to enrollment or a documented history of autoimmune disease.
• Prior allogeneic bone marrow transplantation or solid organ transplantation.
• Pregnant women (positive pregnancy test prior to treatment initiation) or lactating women.

Other illness

• History of another malignancy within 5 years prior to enrollment, with the exception of adequately treated basal cell carcinoma or squamous cell carcinoma of the skin, or carcinoma in situ of the cervix following curative therapy.
• Active or uncontrolled severe infection, defined as grade \>= 2 according to the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
• Known human immunodeficiency virus (HIV) infection, or a history of clinically significant liver disease, including viral hepatitis: known hepatitis B virus (HBV) carriers must be excluded if active HBV infection is present, defined as HBV DNA positivity (\> 1 x 10\^4 copies/mL or \> 2000 IU/mL); known hepatitis C virus (HCV) infection with positive HCV RNA (\> 1 x 10\^3 copies/mL).
• Any condition that, in the opinion of the investigator, makes the patient inappropriate for inclusion in this trial.

Lab values

• Clinically significant cardiovascular disease, including but not limited to: acute myocardial infarction, severe or unstable angina, or coronary artery bypass grafting within 6 months prior to enrollment; congestive heart failure classified as New York Heart Association (NYHA) functional class \> II; ventricular arrhythmias requiring pharmacologic treatment; or left ventricular ejection fraction (LVEF) \< 50%.
• Any other disease, clinically significant metabolic disorder, abnormal physical examination finding, or laboratory abnormality that, in the judgment of the investigator, may render the patient unsuitable for study participation (e.g., uncontrolled seizure disorder requiring treatment), interfere with the interpretation of study results, or place the patient at undue risk.

Other

• Inability or unwillingness to comply with the study protocol or required study procedures.

• Patients and their family members must be fully informed of the study procedures and voluntarily provide written informed consent prior to enrollment.
• Age 18-75 years (inclusive).
• Pathologically confirmed distal gastric adenocarcinoma deemed unresectable due to locally advanced disease, distant metastasis, or peritoneal dissemination (cT4bM0 or T3-4M1, regardless of the clinical lymph node status, stage IV), and therefore unsuitable for curative resection.
• Presence of gastrointestinal obstruction confirmed by upper gastrointestinal contrast radiography or endoscopy, manifested as gastric retention with a Gastric Outlet Obstruction Scoring System (GOOSS) score \<= 1.
• Eastern Cooperative Oncology Group (ECOG) performance status of 0-2 without deterioration within 7 days prior to enrollment.
• American Society of Anesthesiologists (ASA) physical status classification I-III.
• No prior antitumor therapy, including radiotherapy, chemotherapy, targeted therapy, or immunotherapy.