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Zhang J, Li K, Zhang Z, Zhang G, Zhang S, Zhao Y, Gao Z, Ma H, Xie Y, Han J, Zhang L, Zhang B, Liu Y, Wu T, Wu Y, Xiao Y, Wang X. Short-and long-term outcomes of one-stage versus two-stage gastrectomy for perforated gastric cancer: a multicenter retrospective propensity score-matched study. World J Surg Oncol 2024; 22:7. [PMID: 38172888 PMCID: PMC10763372 DOI: 10.1186/s12957-023-03283-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE There is no scientific consensus about the treatment of perforated gastric cancer (PGC). Therefore, the aim of this study was to investigate which is the better treatment option for PGC between the single-stage and two-stage strategies. METHODS All 81 PGC patients from 13 medical institutions were retrospectively enrolled in this study. The PGC patients who underwent R0 gastrectomy were divided into one-stage surgery and two-stage surgery groups. The clinicopathological characteristics of the two groups were compared, and 415 regular gastric cancer patients without perforation were randomly selected as a control. The propensity score matching (PSM) method was used to find matched regular GC patients with similar clinicopathological parameters. The OS (overall survival) and the number harvested lymph nodes from PGC patients and regular GC patients were compared. RESULTS Compared with PGC patients who underwent one-stage surgery, those who underwent two-stage surgery harvested significantly more lymph nodes [31(27, 38) vs 17 (12, 24), P < 0.001], required less blood transfusion [0 (0, 100) vs 200 (0, 800), P = 0.034], had a shorter ICU stay [0 (0, 1.5) vs 3 (0, 3), P = 0.009], and had a significantly better OS (Median OS: 45 months vs 11 months, P = 0.007). Compared with propensity score-matched regular GC patients without perforation, PGC patients who underwent one-stage gastrectomy had a poorer quality of lymphadenectomy [17 (12, 24) vs 29 (21, 37), P < 0.001] and suffered a worse OS (Median OS: 18 months vs 30 months, P = 0.024). Conversely, two-stage gastrectomy can achieve a comparable quality of lymphadenectomy (P = 0.506) and a similar OS (P = 0.096) compared to propensity score-matched regular GC patients. CONCLUSIONS For PGC patients in poor condition, two-stage treatment is a better option when D2 radical gastrectomy cannot be achieved in emergency surgery, based on our findings that two-stage gastrectomy could provide PGC patients with a better quality of lymphadenectomy and a better OS.
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Affiliation(s)
- Junling Zhang
- Department of Gastrointestinal Surgery, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, P. R. China
| | - Kexuan Li
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China
| | - Zongnai Zhang
- Department of General Surgery, Civil Aviation General Hospital, No.1A, Gaojing, Chaoyangmenwai Avenue, Chaoyang District, Beijing, 100123, P. R. China
| | - Guochao Zhang
- Department of General Surgery, China-Japan Friendship Hospital, East Yinghuayuan Street, Chaoyang District, Beijing, 100029, P. R. China
| | - Shupeng Zhang
- Department of General Surgery, Tianjin Fifth Central Hospital, No.41 Zhejiang Road, Binhai New Area, Tianjin, 300450, P. R. China
| | - Yinming Zhao
- Department of General Surgery, Beijing Jingmei Group General Hospital, No.18, Heishan Street, Mentougou District, Beijing, 102399, P. R. China
| | - Zhaoya Gao
- Department of General Surgery, Peking University Shougang Hospital, No.9, Jinyuanzhuang Road, Shijingshan District, Beijing, 100144, P. R. China
| | - Haiyun Ma
- Department of General Surgery, Beijing Miyun District Hospital, Miyun District, No.36 Mixi Road, Beijing, 101500, P. R. China
| | - Yong Xie
- Department of General Surgery, Hebei General Hospital, No.348 Heping West Road, Xinhua District, Shijiazhuang, Hebei Province, 050051, P. R. China
| | - Jinsheng Han
- Department of General Surgery, Cangzhou Integrated Traditional Chinese and Western Medicine Hospital, No.31 Huanghe West Road, Yunhe District, Cangzhou, Hebei Province, 061011, P. R. China
| | - Li Zhang
- Department of General Surgery, First Hospital of Qinhuangdao, No. 258 Wenhua Road, Haigang District, Qinhuangdao, Hebei Province, 066000, P. R. China
| | - Baoliang Zhang
- Department of General Surgery, Tangshan Workers' Hospital, No.27, Wenhua Road, Tangshan, Hebei Province, 063003, P. R. China
| | - Yang Liu
- Department of General Surgery, North China University of Science and Technology Affiliated Hospital, No.73 Jianshe South Road, Lubei District, Tangshan, Hebei Province, 063000, P. R. China
| | - Tao Wu
- Department of Gastrointestinal Surgery, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, P. R. China
| | - Yingchao Wu
- Department of Gastrointestinal Surgery, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, P. R. China.
| | - Yi Xiao
- Division of Colorectal Surgery, Department of General Surgery, Peking Union Medical College Hospital, No.1 Shuaifuyuan Wangfujing Street, Dongcheng District, Beijing, 100730, P. R. China.
| | - Xin Wang
- Department of Gastrointestinal Surgery, Peking University First Hospital, No.8, Xishiku Street, Xicheng District, Beijing, 100034, P. R. China.
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Perforated Carcinoma in the Gastric Remnant: A Case of Conservative Treatment Prior to Successful Curative R0 Resection. Case Rep Surg 2016; 2016:4091952. [PMID: 27651972 PMCID: PMC5019927 DOI: 10.1155/2016/4091952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/18/2016] [Accepted: 08/22/2016] [Indexed: 11/17/2022] Open
Abstract
An 80-year-old man who had undergone distal gastrectomy and Billroth-II gastrojejunostomy 38 years previously, for a benign gastric ulcer, was diagnosed with remnant gastric cancer based on upper gastrointestinal endoscopy findings. He presented at our emergency department with acute-onset epigastric pain due to perforated remnant gastric cancer. Conservative medical management was selected, including nasogastric tube insertion, antibiotics, and proton pump inhibitors, because his peritonitis was limited to his epigastrium and his general condition was stable. Twenty-one days after the perforation occurred, curative total remnant gastrectomy and D2 lymphadenectomy were performed. Adhesion between the lateral segment of the liver and the dissected lesser curvature of the gastric remnant may have contributed to the peritonitis in this case, which was limited to the epigastrium. This is the first report of perforated remnant gastric cancer in which conservative treatment was effective prior to curative resection. The protocol reported here may be of use to other clinicians who may encounter this clinical entity in their practices.
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Roviello F, Rossi S, Marrelli D, De Manzoni G, Pedrazzani C, Morgagni P, Corso G, Pinto E. Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol 2006; 4:19. [PMID: 16573818 PMCID: PMC1524767 DOI: 10.1186/1477-7819-4-19] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2005] [Accepted: 03/30/2006] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Perforation is a rare complication of gastric carcinoma, accounting for less than 1% of all gastric cancer cases. The aim of the present study is to evaluate the prognostic value of perforation and to point out the surgical treatment options. METHODS A total of 10 patients with perforated gastric carcinoma were retrospectively reviewed among 2564 consecutive cases of gastric cancer operated in three Centers belonging to the Italian Research Group for Gastric Cancer. The clinicopathological features including tumor stage and survival were analyzed and compared to literature data. RESULTS Incidence rate was 0.39%. All patients underwent emergency surgery, being performed gastrectomy in 6 patients (mortality 17%) and repair surgery in 4 patients (mortality 75%). The survival of patients was related to the stage of the disease, with 2 long-survival cases. CONCLUSION Perforation usually occurs in advanced stages of gastric cancer; nevertheless surgeons should not be always discouraged from a radical treatment of perforated gastric cancer, since perforation even occurs in early stages and seems not to be a negative prognostic factor itself. When possible, emergency gastrectomy should be performed, leaving repair surgery for unresectable tumors. A two-stage treatment is a good treatment option for frail patients with resectable tumors.
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Affiliation(s)
- Franco Roviello
- Dipartimento di Chirurgia Generale ed Oncologica, University of Siena, Italy
| | - Simone Rossi
- Dipartimento di Chirurgia Generale ed Oncologica, University of Siena, Italy
| | - Daniele Marrelli
- Dipartimento di Chirurgia Generale ed Oncologica, University of Siena, Italy
| | | | | | - Paolo Morgagni
- Divisione di Chirurgia 1, G.B. Morgagni Hospital, Forlì, Italy
| | - Giovanni Corso
- Dipartimento di Chirurgia Generale ed Oncologica, University of Siena, Italy
| | - Enrico Pinto
- Dipartimento di Chirurgia Generale ed Oncologica, University of Siena, Italy
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