1
|
Leder Macek AJ, Wang A, Turgeon MK, Lee RM, Russell MC, Porembka MR, Alterio R, Ju M, Kronenfeld J, Goel N, Datta J, Maker AV, Fernandez M, Richter H, Berman RS, Correa-Gallego C, Lee AY. Diagnostic laparoscopy is underutilized in the staging of gastric adenocarcinoma regardless of hospital type: An US safety net collaborative analysis. J Surg Oncol 2022; 126:649-657. [PMID: 35699351 PMCID: PMC10029827 DOI: 10.1002/jso.26972] [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: 02/09/2022] [Revised: 05/12/2022] [Accepted: 05/22/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Diagnostic laparoscopy (DL) is a key component of staging for locally advanced gastric adenocarcinoma (GA). We hypothesized that utilization of DL varied between safety net (SNH) and affiliated tertiary referral centers (TRCs). METHODS Patients diagnosed with primary GA eligible for DL were identified from the US Safety Net Collaborative database (2012-2014). Clinicopathologic factors were analyzed for association with use of DL and findings on DL. Overall survival (OS) was analyzed by Kaplan-Meier method. RESULTS Among 233 eligible patients, 69 (30%) received DL, of which 24 (35%) were positive for metastatic disease. Forty percent of eligible SNH patients underwent DL compared to 21.5% at TRCs. Lack of insurance was significantly associated with decreased use of DL (OR 0.48, p < 0.01), while African American (OR 6.87, p = 0.02) and Asian race (OR 3.12, p ≤ 0.01), signet ring cells on biopsy (OR 3.14, p < 0.01), and distal tumors (OR 1.62, p < 0.01) were associated with increased use. Median OS of patients with a negative DL was better than those without DL or a positive DL (not reached vs. 32 vs. 12 months, p < 0.005, Figure 1). CONCLUSIONS Results from DL are a strong predictor of OS in GA; however, the procedure is underutilized. Patients from racial minority groups were more likely to undergo DL, which likely accounts for higher DL rates among SNH patients.
Collapse
Affiliation(s)
- Aleeza J. Leder Macek
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Annie Wang
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Michael K. Turgeon
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Rachel M. Lee
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Maria C. Russell
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Matthew R. Porembka
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Rodrigo Alterio
- Department of Surgery, Division of Surgical Oncology, University of Texas Southwestern Medical School, Dallas, Texas, USA
| | - Michelle Ju
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Joshua Kronenfeld
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Neha Goel
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Jashodeep Datta
- Department of Surgery, Division of Surgical Oncology, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, Miami, Florida, USA
| | - Ajay V. Maker
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Manuel Fernandez
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Harry Richter
- Department of Surgery, John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Russell S. Berman
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Camilo Correa-Gallego
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| | - Ann Y. Lee
- Department of Surgery, Division of Surgical Oncology, NYU Langone Health, New York, New York, USA
| |
Collapse
|
2
|
Stilidi IS, Sigua BV, Zemlyanoy VP, Kurkov AA, Gubkov II. [Gastric cancer complicated by bleeding. (A systematic review)]. Khirurgiia (Mosk) 2022:102-115. [PMID: 35658142 DOI: 10.17116/hirurgia2022061102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.
Collapse
Affiliation(s)
- I S Stilidi
- Blokhin National Cancer Research Center, Moscow, Russia
| | - B V Sigua
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - V P Zemlyanoy
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A A Kurkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - I I Gubkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| |
Collapse
|
3
|
Stilidi IS, Sigua BV, Zemlyanoy VP, Kurkov AA, Gubkov II. [Gastric cancer complicated by bleeding: a systematic review]. Khirurgiia (Mosk) 2022:101-114. [PMID: 35289556 DOI: 10.17116/hirurgia2022031101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bleeding as the most common complication of gastric cancer is a significant problem of modern surgery. Both oncologists and surgeons in ordinary hospitals deal with this adverse event. In addition to the well-known drugs for hemostasis, there are also generally recognized traditional methods of endoscopic hemostasis and transcatheter angiographic embolization. Surgical interventions do not lose their role too if previous hemostatic methods turned out to be ineffective. The reports devoted to radiotherapy for treatment and prevention of gastric bleeding following malignant process have been recently published. Such a wide choice of hemostatic methods prompted us to analyze the most significant recent studies regarding effectiveness of various methods and choice of the most optimal one.
Collapse
Affiliation(s)
- I S Stilidi
- Blokhin National Cancer Research Center, Moscow, Russia
| | - B V Sigua
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - V P Zemlyanoy
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - A A Kurkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| | - I I Gubkov
- Mechnikov North-Western State Medical University, St. Petersburg, Russia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Hoshino N, Endo H, Hida K, Ichihara N, Takahashi Y, Hasegawa H, Kimura T, Kitagawa Y, Kakeji Y, Miyata H, Nakayama T, Sakai Y. Emergency surgery for gastrointestinal cancer: A nationwide study in Japan based on the National Clinical Database. Ann Gastroenterol Surg 2020; 4:549-561. [PMID: 33005850 PMCID: PMC7511565 DOI: 10.1002/ags3.12353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Emergency gastrointestinal surgery, although rare, is known for its high mortality and morbidity. However, the risks of emergency surgery for gastrointestinal cancer have not been investigated in depth. This study aimed to investigate the impact of emergency surgery on mortality and morbidity in patients with gastrointestinal cancers and to identify associated risk factors. METHODS We extracted data from the National Clinical Database, a nationwide surgery registration system in Japan, for patients with gastrointestinal cancer who underwent esophageal resection, total gastrectomy, distal gastrectomy, right hemicolectomy, or low anterior resection between 2012 and 2017. The impacts of emergency surgery on 30-day mortality and incidence of overall postoperative complications were compared with those of non-emergency surgery. Risk factors for mortality and overall postoperative complications were then sought in patients who underwent emergency surgery. RESULTS Thirty-day mortality and incidence of overall postoperative complications were significantly higher in emergency surgeries for gastric, colon, and rectal cancers than in non-emergency surgeries (odds ratios 4.86-6.98 and 1.68-2.18, respectively; all P < .001). Various risk factors were identified in the group that underwent emergency surgery, including preoperative sepsis and lower body mass index. Some of the risk factors were common to all types of surgery and others were specific to a certain type of surgery. CONCLUSION The actual risk of emergency surgery and the risk factors for overall postoperative complications in emergency cases are shown to serve as a reference for postoperative management. Emergency surgery had an additional burden on patients depending on the type of surgery.
Collapse
Affiliation(s)
- Nobuaki Hoshino
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
- Department of Health InformaticsKyoto University School of Medicine and Public HealthKyotoJapan
| | - Hideki Endo
- Department of Healthcare Quality AssessmentTokyo University Graduate School of MedicineTokyoJapan
| | - Koya Hida
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| | - Nao Ichihara
- Department of Healthcare Quality AssessmentTokyo University Graduate School of MedicineTokyoJapan
| | - Yoshimitsu Takahashi
- Department of Health InformaticsKyoto University School of Medicine and Public HealthKyotoJapan
| | - Hiroshi Hasegawa
- Department of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Toshimoto Kimura
- Department of SurgeryIwate Medical University School of MedicineIwateJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentTokyo University Graduate School of MedicineTokyoJapan
| | - Takeo Nakayama
- Department of Health InformaticsKyoto University School of Medicine and Public HealthKyotoJapan
| | - Yoshiharu Sakai
- Department of SurgeryKyoto University Graduate School of MedicineKyotoJapan
| |
Collapse
|
6
|
Fan FS, Yang CF. Chemotherapy-induced necrotising tumour lysis and perforation of a huge gastric cancer simulating emphysematous pancreatitis. Ecancermedicalscience 2020; 14:1054. [PMID: 32582369 PMCID: PMC7302892 DOI: 10.3332/ecancer.2020.1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Indexed: 12/24/2022] Open
Abstract
A 56-year-old man was diagnosed to have a huge gastric cancer extending from the lesser curvature of the stomach to the pancreas with multiple hepatic and peritoneal metastases. Two days after completing chemotherapy with cisplatin plus high dose leucovorin and fluorouracil, drastic necrotising tumour lysis led to gastric perforation and septic shock most likely due to bacterial peritonitis. The image of tumour lysis looked like an emphysematous pancreatitis. Afterwards, immunohistochemical study of the tumour specimen confirmed moderate positivity of dihydropyrimidine dehydrogenase and absence of Bcl-2 expression. The incomplete expression of dihydropyrimidine dehydrogenase and total deficiency of Bcl-2 are considered to be the main underlying causes of such extraordinary chemosensitivity and so severe a tumour lysis phenomenon. Pre-emptive intensive survey of possible biomarkers of chemosensitivity is thus highly recommended upon treating a massive gastric cancer.
Collapse
Affiliation(s)
- Frank S Fan
- Section of Haematology and Oncology, Department of Medicine, Ministry of Health and Welfare Changhua Hospital, Chang-Hua County, Taiwan.,https://orcid.org/0000-0002-8123-6941
| | - Chung-Fan Yang
- Department of Pathology, Ministry of Health and Welfare Changhua Hospital, Chang-Hua County, Taiwan.,https://orcid.org/0000-0002-7366-4380
| |
Collapse
|
7
|
Wang SY, Hsu CH, Liao CH, Fu CY, Ouyang CH, Cheng CT, Hsu JT, Yeh TS, Yeh CN. Surgical outcome evaluation of perforated gastric cancer: from the aspects of both acute care surgery and surgical oncology. Scand J Gastroenterol 2017; 52:1371-1376. [PMID: 28838270 DOI: 10.1080/00365521.2017.1369562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Perforated gastric cancer (PGC) is a rare condition of gastric cancer (GC). In this study, we sought to assess the outcome of PGC from the aspects of both acute care surgery and surgical oncology at a single institute, Chang Gung Memorial Hospital (CGMH). METHODS From 1997 to 2013, 6864 patients were diagnosed with GC and 2738 were diagnosed with gastroduodenal perforation at CGMH. In total, 29 patients with PGC were identified. Immediate surgical and long-term oncologic outcomes were evaluated after an appropriate matching process was performed. RESULTS The immediate surgical outcome of PGC, i.e., the hospital mortality rate within 30 d after surgery, did not significantly differ from that of non-cancer related gastroduodenal perforation. The long-term oncologic outcome, with matching by age, gender, year of surgery and AJCC 7th stage grouping, also did not significantly differ from that of GC without perforation. CONCLUSIONS Aggressive surgical treatment, including an initial emergency procedure for containing peritonitis and radical surgery for GC, may benefit PGC patients in terms of both the immediate and oncologic outcomes.
Collapse
Affiliation(s)
- Shang-Yu Wang
- a Division of Trauma and Emergency Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC.,b Graduate Institute of Clinical Medical Sciences , Chang Gung University , Taoyuan City , ROC
| | - Chih-Ho Hsu
- c Department of Surgery, Division of General Surgery , Far-Eastern Memorial Hospital , New Taipei City , ROC
| | - Chien-Hung Liao
- a Division of Trauma and Emergency Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC
| | - Chih-Yuan Fu
- a Division of Trauma and Emergency Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC
| | - Chun-Hsiang Ouyang
- a Division of Trauma and Emergency Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC
| | - Chi-Tung Cheng
- a Division of Trauma and Emergency Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC
| | - Jun-Te Hsu
- d Division of General Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC
| | - Ta-Sen Yeh
- d Division of General Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC
| | - Chun-Nan Yeh
- d Division of General Surgery , Chang Gung Memorial Hospital , Taoyuan City , ROC
| |
Collapse
|
8
|
Xiao H, Ma M, Xiao Y, Ouyang Y, Tang M, Zhou K, Hong Y, Tang B, Zuo C. Incomplete resection and linitis plastica are factors for poor survival after extended multiorgan resection in gastric cancer patients. Sci Rep 2017; 7:15800. [PMID: 29150634 PMCID: PMC5694005 DOI: 10.1038/s41598-017-16078-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 11/07/2017] [Indexed: 12/12/2022] Open
Abstract
The aim of this retrospective study was to analyze the morbidity, mortality, and survival rates of extended multiorgan resection (EMR) for locally advanced gastric cancer patients compared to gastrectomy alone and a palliative operation. 893 locally advanced gastric cancer patients without distant metastasis had surgery including gastrectomy alone (GA group, n = 798), EMR resection (EMR group, n = 75), and palliative operation (palliative gastrectomy or gastrojejunostomy (PO group, n = 20)). Postoperative mortality and complication rates in the EMR group were significantly higher than in the GA group (2.7% vs 0.4%, P = 0.010 and 25.3% vs 8.1%, P < 0.001, respectively), but similar in the PO group. The median survival time of the EMR group was significantly longer than in the PO group (27 months vs 11 months, P = 0.020), but significantly worse (P = 0.020) than in the GA group (44 months). Incompleteness of resection (R1) and linitis plastica were independent prognostic factors for survival in the EMR group. Three different gastric cancer surgeries led to different postoperative mortality and complication rates. EMR had a better survival rate compared with PO while GA had the longest survival time with the lowest mortality and complication rates.
Collapse
Affiliation(s)
- Hua Xiao
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Min Ma
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yanping Xiao
- Department of Admissions and Employment, Changsha Health Vocational College, Changsha, 410010, China
| | - Yongzhong Ouyang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Ming Tang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Kunyan Zhou
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Yuan Hong
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Bo Tang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China
| | - Chaohui Zuo
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, 410013, China.
| |
Collapse
|
9
|
Park S, Shin JH, Gwon DI, Kim HJ, Sung KB, Yoon HK, Ko GY, Ko HK. Transcatheter Arterial Embolization for Gastrointestinal Bleeding Associated with Gastric Carcinoma: Prognostic Factors Predicting Successful Hemostasis and Survival. J Vasc Interv Radiol 2017; 28:1012-1021. [PMID: 28483303 DOI: 10.1016/j.jvir.2017.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 03/12/2017] [Accepted: 03/13/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To evaluate outcomes of transcatheter arterial embolization (TAE) for gastric cancer-related gastrointestinal (GI) bleeding and factors associated with successful TAE and improved survival after TAE. MATERIALS AND METHODS This retrospective study included 43 patients (34 men; age 60.6 y ± 13.6) with gastric cancer-related GI bleeding undergoing angiography between January 2000 and December 2015. Clinical course, laboratory findings, and TAE characteristics were reviewed. Technical success of TAE was defined as target area devascularization, and clinical success was defined as bleeding cessation with hemodynamic stability during 72 hours after TAE. Student t test was used for comparison of continuous variables, and Fisher exact test was used for categorical variables. Univariate and multivariate analysis were performed to identify predictors of successful TAE and 30-day survival after TAE. RESULTS TAE was performed in 40 patients. Technical and clinical success rates of TAE were 85.0% and 65.0%, respectively. Splenic infarction occurred in 2 patients as a minor complication. Rebleeding after TAE occurred in 7 patients. Death related to bleeding occurred in 5 patients. Active bleeding (P = .044) and higher transfusion requirement (3.3 U ± 2.6 vs 1.8 U ± 1.7; P = .039) were associated with TAE failure. Successful TAE predicted improved 30-day survival after TAE on univariate and multivariate analysis (P = .018 and P = .022; odds ratio, 0.132). CONCLUSION TAE for gastric cancer-associated GI bleeding may be a lifesaving procedure. Severe bleeding with a higher transfusion requirement and active bleeding on angiography predicted TAE failure.
Collapse
Affiliation(s)
- Sangik Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea.
| | - Dong-Il Gwon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Hyoung Jung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Kyu-Bo Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Hyun-Ki Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Gi-Young Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
| | - Heung Kyu Ko
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul 138-736, Korea
| |
Collapse
|
10
|
Torres VBL, Vassalo J, Silva UVA, Caruso P, Torelly AP, Silva E, Teles JMM, Knibel M, Rezende E, Netto JJS, Piras C, Azevedo LCP, Bozza FA, Spector N, Salluh JIF, Soares M. Outcomes in Critically Ill Patients with Cancer-Related Complications. PLoS One 2016; 11:e0164537. [PMID: 27764143 PMCID: PMC5072702 DOI: 10.1371/journal.pone.0164537] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 09/27/2016] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Cancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients. MATERIALS AND METHODS Secondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality. RESULTS Out of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94-1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11-12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57-5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04-3.71), P = 0.038] were independently associated with in-hospital mortality. CONCLUSIONS The prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.
Collapse
Affiliation(s)
- Viviane B. L. Torres
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliana Vassalo
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | - Pedro Caruso
- ICU, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - André P. Torelly
- Rede Institucional de Pesquisa e Inovação em Medicina Intensiva (RIPIMI), Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Eliezer Silva
- ICU, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Marcos Knibel
- Hospital São Lucas, Travessa Frederico Pamplona 32, Rio de Janeiro, Brazil
| | - Ederlon Rezende
- ICU, Hospital do Servidor Público Estadual, São Paulo, Brazil
| | - José J. S. Netto
- ICU, Instituto Nacional de Câncer, Hospital do Câncer II, Rio de Janeiro, Brazil
| | | | | | - Fernando A. Bozza
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
| | - Nelson Spector
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Jorge I. F. Salluh
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Marcio Soares
- Postgraduate Program in Internal Medicine, School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, Brazil
- Postgraduate Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
- * E-mail:
| |
Collapse
|
11
|
Ignjatovic N, Stojanov D, Djordjevic M, Ignjatovic J, Benedeto Stojanov D, Milojkovic B. Perforation of gastric cancer - What should the surgeon do? Bosn J Basic Med Sci 2016; 16:222-6. [PMID: 27131023 DOI: 10.17305/bjbms.2016.1020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/24/2016] [Accepted: 02/24/2016] [Indexed: 12/17/2022] Open
Abstract
Perforation represents a rare and severe complication of gastric cancer (GC) with a large hospital mortality (8-82%). The aim of this study is to evaluate the clinical-pathological features in patients with perforated gastric cancer (PGC) and to advise the surgical treatment options. A total of 11 patients with PGC were retrospectively reviewed among 376 consecutive cases of GC operated. The clinical-pathological features including tumor stage, survival, and the type of treatment were observed. The perforation was more frequent in stage III (8 patients) and in stage IV (3 patients), but none of the cases in stage I and II GC were observed. All the patients had serosal invasion and lymph node metastasis. Limited lymphadenectomy (D0, D1) was performed in 5 patients, and extended lymphadenectomy (D2, D3) in 3 patients. Emergency gastrectomy was performed in 8 (72.8%) patients, subtotal gastrectomy in 5 (45.5%), and total gastrectomy in 3 (27.2%) cases. Three (27.2%) patients were treated by simple closure with omental patch. The overall 30-day mortality rate was 46%. The survival rate was higher among the patients who underwent curative resection (75.77±68.88 days) than in those who underwent simple closure with omental patch (18.00±24.43 days). The difference between the treatments in these groups was significant (p < 0.05). PGC required surgical emergency. Curative resection improved long-term survival in the patients with potentially curable gastric malignancy. Unsuccessful outcomes after PGC could be attributed to the poor condition of the patients and the advanced disease stage.
Collapse
Affiliation(s)
- Nebojsa Ignjatovic
- Clinic of General Surgery, Clinical Center Nis, Nis, Serbia School of Medicine, University of Nis, Nis, Serbia.
| | | | | | | | | | | |
Collapse
|
12
|
Lee HH, Park JM, Chun HJ, Oh JS, Ahn HJ, Choi MG. Transcatheter arterial embolization for endoscopically unmanageable non-variceal upper gastrointestinal bleeding. Scand J Gastroenterol 2015; 50:809-15. [PMID: 25732964 DOI: 10.3109/00365521.2014.990503] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Transcatheter arterial embolization (TAE) is a therapeutic option for endoscopically unmanageable upper gastrointestinal (GI) bleeding. We aimed to assess the efficacy and clinical outcomes of TAE for acute non-variceal upper GI bleeding and to identify predictors of recurrent bleeding within 30 days. MATERIALS AND METHODS Visceral angiography was performed in 66 patients (42 men, 24 women; mean age, 60.3 ± 12.7 years) who experienced acute non-variceal upper GI bleeding that failed to be controlled by endoscopy during a 7-year period. Clinical information was reviewed retrospectively. Outcomes included technical success rates, complications, and 30-day rebleeding and mortality rates. RESULTS TAE was feasible in 59 patients. The technical success rate was 98%. Rebleeding within 30 days was observed in 47% after an initial TAE and was managed with re-embolization in 8, by endoscopic intervention in 5, by surgery in 2, and by conservative care in 12 patients. The 30-day overall mortality rate was 42.4%. In the case of initial endoscopic hemostasis failure (n = 34), 31 patients underwent angiographic embolization, which was successful in 30 patients (96.8%). Rebleeding occurred in 15 patients (50%), mainly because of malignancy. Two factors were independent predictors of rebleeding within 30 days by multivariate analysis: coagulopathy (odds ratio [OR] = 4.37; 95% confidence interval [CI]: 1.25-15.29; p = 0.021) and embolization in ≥2 territories (OR = 4.93; 95% CI: 1.43-17.04; p = 0.012). Catheterization-related complications included hepatic artery dissection and splenic embolization. CONCLUSION TAE controlled acute non-variceal upper GI bleeding effectively. TAE may be considered when endoscopic therapy is unavailable or unsuccessful. Correction of coagulopathy before TAE is recommended.
Collapse
Affiliation(s)
- Han Hee Lee
- Department of Internal Medicine, Division of Gastroenterology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Korea
| | | | | | | | | | | |
Collapse
|
13
|
Bosscher MRF, van Leeuwen BL, Hoekstra HJ. Surgical emergencies in oncology. Cancer Treat Rev 2014; 40:1028-36. [PMID: 24933674 DOI: 10.1016/j.ctrv.2014.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 02/06/2023]
Abstract
An oncologic emergency is defined as an acute, potentially life threatening condition in a cancer patient that has developed as a result of the malignant disease or its treatment. Many oncologic emergencies are signs of advanced, end-stage malignant disease. Oncologic emergencies can be divided into medical or surgical. The literature was reviewed to construct a summary of potential surgical emergencies in oncology that any surgeon can be confronted with in daily practice, and to offer insight into the current approach for these wide ranged emergencies. Cancer patients can experience symptoms of obstruction of different structures and various causes. Obstruction of the gastrointestinal tract is the most frequent condition seen in surgical practice. Further surgical emergencies include infections due to immune deficiency, perforation of the gastrointestinal tract, bleeding events, and pathological fractures. For the institution of the appropriate treatment for any emergency, it is important to determine the underlying cause, since emergencies can be either benign or malignant of origin. Some emergencies are well managed with conservative or non-invasive treatment, whereas others require emergency surgery. The patient's performance status, cancer stage and prognosis, type and severity of the emergency, and the patient's wishes regarding invasiveness of treatment are essential during the decision making process for optimal management.
Collapse
Affiliation(s)
- M R F Bosscher
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, HPC BA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - B L van Leeuwen
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, HPC BA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | - H J Hoekstra
- Department of Surgical Oncology, University of Groningen, University Medical Center Groningen, HPC BA31, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| |
Collapse
|
14
|
Tan KK, Quek TJL, Wong N, Li KK, Lim KH. Emergency surgery for perforated gastric malignancy: An institution's experience and review of the literature. J Gastrointest Oncol 2012; 2:13-8. [PMID: 22811822 DOI: 10.3978/j.issn.2078-6891.2011.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 01/05/2011] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The aim was to evaluate the outcome of patients who underwent surgery for perforated gastric malignancies. METHODS A review of all patients who underwent surgery for perforated gastric malignancy was performed. RESULTS Twelve patients (nine gastric adenocarcinoma and three B-cell lymphoma) formed the study group. Ten (83.3%) had subtotal gastrectomy performed, while two (16.7%) underwent total gastrectomy. All eight patients with adenocarcinoma who survived the initial operation fared poorly. The two patients with lymphoma who survived the surgery underwent subsequent chemotherapy has no disease recurrence currently. CONCLUSION Surgery in perforated gastric malignancy is fraught with numerous challenges.
Collapse
Affiliation(s)
- Ker-Kan Tan
- Digestive Disease Centre, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | | | | | | |
Collapse
|
15
|
Akita H, Watanabe Y, Ishida H, Nakaguchi K, Okino T, Kabuto T. A foreign body granuloma after gastric perforation mimicking peritoneal dissemination of gastric cancer: Report of a case. Surg Today 2009; 39:795-9. [DOI: 10.1007/s00595-008-3937-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Accepted: 10/30/2008] [Indexed: 12/14/2022]
|
16
|
Abstract
Platelet transfusion therapy is the standard of care for thrombocytopenic patients with hemato-oncological disorders and bone marrow failure states due to intensive chemoradiotherapy. Guidelines to lower triggers for prophylactic and therapeutic transfusions are being developed based on better levels of evidence. The optimum transfusion dose, the choice of platelet concentrate and transfusion interval pose a challenge to balance scientific advances with cost-effective strategies. Platelet refractoriness requires "matched" platelets and is a difficult to treat phenomenon. Pathogen inactivation is a crucial issue in view of susceptibility of platelet concentrates to bacterial contamination. This article reviews the current developments and challenges in optimizing platelet transfusion therapy.
Collapse
Affiliation(s)
- Neelam Marwaha
- Department of Transfusion Medicine, PGIMER, Chandigarh, India.
| | | |
Collapse
|
17
|
Trébol J, Herreros D, Ángel Gombáu M, García-Sancho L. Hidroneumotórax e hidroneumomediastino secundarios a tumor gástrico. Cir Esp 2009; 85:54-5. [PMID: 19239938 DOI: 10.1016/s0009-739x(09)70088-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
|
18
|
Kotan C, Sumer A, Baser M, Kızıltan R, Carparlar MA. An analysis of 13 patients with perforated gastric carcinoma: A surgeon's nightmare? World J Emerg Surg 2008; 3:17. [PMID: 18471321 PMCID: PMC2397385 DOI: 10.1186/1749-7922-3-17] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Accepted: 05/10/2008] [Indexed: 11/10/2022] Open
Abstract
Background and Objectives Perforation is a rare complication of gastric carcinoma and generally not diagnosed preoperatively. To clarify the clinicopathologic characteristics of patients with this condition we reviewed 13 cases of gastric cancer perforation who required emergency surgery. Methods A total of 13 patients with gastric cancer perforation were retrospectively reviewed. The clinicopathological features including tumor stage and survival and also the type of treatment were analyzed and compared to literature data. Results There were 13 patients (10 males and 3 females) with a mean age of 59.0 ± 9.56 years. The incidence of perforated gastric cancer was 9.6% among gastric carcinoma and 4.2% of all gastric perforation cases. The perforation was more frequently in stage III–IV (2–10), but one case of stage II (T3N0M0) gastric cancer was also observed. None of the patients had curative resection or radical lymph-node dissection. Six (46%) patients were treated by palliative, local surgery. Emergency gastrectomy were performed in 7 (54%) patients. Overall 30-day mortality rate was % 46. The overall survival time was 128.2 ± 184.8 days for all patients, it was 52.8 ± 52.9 days for locally treated group, and 192.9 ± 235.4 days for patients who underwent resectional surgery. The difference between the treatment groups was not significant Conclusion Perforation usually occurs in advanced stages of gastric cancer. These patients had a poor prognosis because of the presence of advanced cancer.
Collapse
Affiliation(s)
- Cetin Kotan
- Department of Surgery, Kaş State Hospital, Antalya, Turkey.
| | | | | | | | | |
Collapse
|