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Amalia R, Vidyani A, I’tishom R, Efendi WI, Danardono E, Wibowo BP, Parewangi ML, Miftahussurur M, Malaty HM. The Prevalence, Etiology and Treatment of Gastroduodenal Ulcers and Perforation: A Systematic Review. J Clin Med 2024; 13:1063. [PMID: 38398375 PMCID: PMC10888557 DOI: 10.3390/jcm13041063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Gastroduodenal perforation (GDP) is a life-threatening condition caused by a spontaneous or traumatic event. Treatment should be based on the mechanism of damage, timing, location, extent of the injury, and the patient's clinical condition. We aimed to examine several etiologic factors associated with gastroduodenal perforation and to search for the best method(s) for its prevention and treatment. (2) Methods: We conducted extensive literature reviews by searching numerous studies obtained from PubMed, Science Direct, and Cochrane for the following keywords: gastroduodenal perforation, Helicobacter pylori, NSAIDs' use, side effects of GDP, laparoscopy, and surgery. The primary outcome was the reported occurrence of GDP. (3) Results: Using keywords, 883 articles were identified. After applying the inclusion and exclusion criteria, 53 studies were eligible for the current analyses, with a total number of 34,692 gastroduodenal perforation cases. Even though the risk factors of gastroduodenal perforation are various, the prevalence of H. pylori among patients with perforation is considerably high. As technology develops, the treatment for gastric perforation will also improve, with laparoscopic surgery having a lower mortality and complication rate compared to open surgery for GDP treatment. (4) Conclusions: H. pylori infection plays the most significant role in GDP, more than NSAIDs, surgery, chemotherapy, or transplantation. Treatment of H. pylori infection is essential to decrease the prevalence of GDP and speed up its recovery. However, urgent cases require immediate intervention, such as laparoscopic or open surgery.
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Affiliation(s)
- Rizki Amalia
- Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan;
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60286, Indonesia;
| | - Amie Vidyani
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Reny I’tishom
- Department of Medical Biology, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Wiwin Is Efendi
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Edwin Danardono
- Department of Surgery, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia;
| | - Bogi Pratomo Wibowo
- Department of Endocrinology, Saiful Anwar General Hospital, Malang 65111, Indonesia;
| | - Muhammad Lutfi Parewangi
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Makassar 90245, Indonesia;
| | - Muhammad Miftahussurur
- Helicobacter pylori and Microbiota Study Group, Institute of Tropical Disease, Universitas Airlangga, Surabaya 60286, Indonesia;
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
| | - Hoda M. Malaty
- Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya 60115, Indonesia
- Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
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Mayer P, Héroin L, Mutter D, Oertel L, Pioche M, Habersetzer F, Philouze G. Perforation of the greater gastric curvature by a gastric adenocarcinoma with engulfment of the upper pole of the spleen. Endoscopy 2022; 54:E680-E681. [PMID: 35180792 DOI: 10.1055/a-1743-1628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Pierre Mayer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| | - Lucile Héroin
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| | - Didier Mutter
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Department of Visceral and Digestive Surgery, Pôle Hépato-digestif, Nouvel Hôpital Civil, HUS, Strasbourg, France
| | | | - Mathieu Pioche
- Department of Endoscopy and Hepatogastroenterology, Pavillon L, Edouard Herriot Hospital, Lyon, France
| | - François Habersetzer
- Department of Hepatology and Gastroenterology, Pôle Hépato-digestif, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (HUS), Strasbourg, France.,IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France
| | - Guillaume Philouze
- IHU-Strasbourg (Institut Hospitalo-Universitaire), Strasbourg, France.,Department of Visceral and Digestive Surgery, Pôle Hépato-digestif, Nouvel Hôpital Civil, HUS, Strasbourg, France
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Kim CH, Kim DJ, Kim W. The role of laparoscopic management in perforated gastric cancer. Ann Surg Treat Res 2021; 101:151-159. [PMID: 34549038 PMCID: PMC8424433 DOI: 10.4174/astr.2021.101.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose Perforated gastric cancer is an extremely rare condition and usually presents in advanced stage with poor prognosis. Surgical strategies are still controversial regarding the extent to which complete resection or primary repair is performed and the application of laparoscopic techniques. We aim to determine the role of laparoscopic 2-stage approach in perforated gastric cancer. Methods Among 2,318 gastric cancers in Yeouido St. Mary's Hospital from January 1990 to December 2017, 20 patients with perforated gastric cancer were enrolled, and 5 patients underwent 2-stage gastrectomy consisting of primary closure on perforation followed by curative gastrectomy. Clinicopathological features, surgical outcomes, and survival analysis were evaluated. Results Two-stage approach for perforated gastric cancer was all performed by laparoscopic approach except 1 patient who needed paraaortic lymph node dissection (LND). Those were first treated on peritonitis with laparoscopic primary closure with or without Foley gastrostomy. Compared to 1-stage gastrectomy, more D2 LND was performed (60.0% vs. 100.0%, P = 0.260) and retrieved lymph nodes were significantly higher (median [range]: 17.0 [12.0–27.0] vs. 33.0 [26.5–43.5], P = 0.019]. Two patients of stage II and 3 patients of stage III were included in the 2-stage gastrectomy group. During the 38 months of median follow-up period, there were 8 and 1 recurrence among 1-stage and 2-stage gastrectomies, respectively. Except for 1 patient, 4 other 2-stage patients survived around 5 years without recurrence (5-year disease-free survival, 80%). Conclusion Laparoscopic 2-stage surgery for perforated gastric cancer is safe and might increase the curability of gastrectomy with extended LND.
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Affiliation(s)
- Chang Hwan Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Wook Kim
- Department of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Di Carlo S, Franceschilli M, Rossi P, Cavallaro G, Cardi M, Vinci D, Sibio S. Perforated gastric cancer: a critical appraisal. Discov Oncol 2021; 12:15. [PMID: 35201463 PMCID: PMC8777488 DOI: 10.1007/s12672-021-00410-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023] Open
Abstract
Gastric cancer perforation is a life-threatening condition that accounts for less than 5% of all gastric cancer patients and typically requires emergency surgery. However, preoperative diagnosis is difficult and management has a dual purpose: to treat peritonitis and to achieve a curative resection. The optimal surgical strategy is still unclear and prognosis remains poor. A search of the literature was performed using MEDLINE databases (Pubmed, EMBASE, Web of Science and Cochrane) using terms such as "perforated gastric cancer", "perforated gastric cancer and surgery", "perforated gastric tumour" and "gastric cancer perforated". Case reports, other reviews, non-english written papers and papers written before 2010 were excluded. Eight articles published between 2010 and 2020 matched the inclusion criteria for this review. Perforated gastric cancer was more prevalent in elderly males. Distal stomach was most frequently involved. Preoperative diagnosis was uncommon. Mortality rates ranged from 2 to 46%. Patients able to receive an R0 resection demonstrated better long-term survival compared with patients who had simple closure procedures. Laparoscopic procedure was mentioned only in one study. In an emergency situation, curative RO resection should always be offered in patients without multiple adverse factors. A surgical strategy using laparoscopic local repair as first step of surgery to resolve the peritonitis followed by a radical open or laparoscopic gastrectomy with lymphadenectomy could be considered. A balance between emergency and oncological needs should drive the surgical choice on a case by case basis.
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Affiliation(s)
- Sara Di Carlo
- Department of Surgery, Minimally Invasive Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Marzia Franceschilli
- Department of Surgery, Minimally Invasive Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Piero Rossi
- Department of Surgical Sciences, University of Rome "Tor Vergata", Minimally Invasive Unit, Tor Vergata Hospital, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery Pietro Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Maurizio Cardi
- Department of Surgery Pietro Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Danilo Vinci
- Department of Surgery, Minimally Invasive Unit, University of Rome "Tor Vergata", Rome, Italy
| | - Simone Sibio
- Department of Surgery Pietro Valdoni, Unit of Oncologic and Minimally Invasive Surgery, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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A Perforated Gastric Carcinoma: A Single-Center Experience. Int Surg 2020. [DOI: 10.9738/intsurg-d-17-00069.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
In this study, we aimed to describe clinicopathologic characteristics of the patients with a perforated gastric carcinoma, and to assess surgical approaches and possible factors affecting mortality and morbidity.
Material and Method
We retrospectively reviewed data of 18 patients who underwent emergent surgery for a perforated gastric carcinoma between January 2002 and December 2012. Data including surgical procedure, pathologic findings, complications, morbidity and mortality rates, and outcomes were evaluated.
Results
The mean age was 58 years. The most common tumor localization was antrum (55%), and 11 patients (61.1%) had Stage IV disease. Nine patients (50%) had a comorbid disease. Of the patients, primary suture + omentopexy was performed in 11 (61.1%) whereas total gastrectomy with D0 or D1 lymph node dissection in 5 (27.7%), subtotal gastrectomy with D0 lymph node dissection in 2 (11.1%), and 2-stage total gastrectomy with D2 lymph node dissection in 2 (11.1%). The complication rate was 50% with a mortality rate of 50%. Overall survival was 79 ± 97.89 days. Sepsis and the presence of comorbidities were found to increase early mortality (P = 0.00 and P = 0.028)
Conclusion
Our study results show that postoperative morbidity and mortality rates are still high in patients with a perforated gastric carcinoma. In stable patients, 1-step radical gastrectomy should be performed, while palliative surgery or 2-stage radical gastrectomy can be performed in patients with poor overall status and diffuse peritonitis. Early diagnosis and perforation management before the onset of diffuse peritonitis can decrease high mortality and morbidity rates.
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Dormagen JB, Verma N, Fink KR. Imaging in Oncologic Emergencies. Semin Roentgenol 2020; 55:95-114. [PMID: 32438984 DOI: 10.1053/j.ro.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Nupur Verma
- Department of Radiology, University of Florida, Gainesville, FL
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Melloni M, Bernardi D, Asti E, Bonavina L. Perforated Gastric Cancer: A Systematic Review. J Laparoendosc Adv Surg Tech A 2019; 30:156-162. [PMID: 31545122 DOI: 10.1089/lap.2019.0507] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Although gastric carcinoma is the fifth most commonly diagnosed cancer, optimal treatment of perforated cancer remains debated. Materials and Methods: The study was conducted according to the guidelines from the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. An electronic systematic search was conducted using MEDLINE databases (PubMed, EMBASE, and Web of Science) by matching the terms "perforated gastric cancer," "gastric cancer perforated," "perforation AND gastric cancer," and "perforated gastric tumor." Results: Fifteen studies published between 1995 and 2018 and including 964 patients matched the inclusion criteria for this systematic review. There were 4 publications from Japan, 3 from Turkey, and 1 from China, Germany, Hong Kong, Italy, Nepal, Serbia, South Korea, and Taiwan, respectively. The sample size of the individual studies ranged from 8 to 514 patients. Perforated gastric carcinoma was rare and more prevalent in elderly males, preoperative diagnosis was uncommon, and the distal stomach was most frequently involved. Mortality was 11.4% and 1.9%, respectively, in one-stage versus two-stage gastrectomy (P = .010). Curative treatment by omental patch repair and staged gastrectomy yielded acceptable 5-year survival rates. There were no significant differences in the recurrence rate and pattern between perforated and nonperforated gastric cancer if a curative operation was performed. Use of laparoscopy was mentioned only in one study. Conclusions: Future studies should evaluate the role of laparoscopic surgery and clarify the indications for hyperthermic intraperitoneal chemotherapy and extensive peritoneal lavage protocols to decrease gastric cancer cell shed in the surgical field and increase long-term survival.
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Affiliation(s)
- Matteo Melloni
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milan, San Donato Milanese, Milano, Italy
| | - Daniele Bernardi
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milan, San Donato Milanese, Milano, Italy
| | - Emanuele Asti
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milan, San Donato Milanese, Milano, Italy
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, Department of Biomedical Sciences for Health, University of Milan, San Donato Milanese, Milano, Italy
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Wu FH, Chiang RA, Tsai YC, Hung ST, Huang SS. Perforated gastric carcinoma in a young-age patient. JOURNAL OF CANCER RESEARCH AND PRACTICE 2018. [DOI: 10.1016/j.jcrpr.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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