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Linder G, McGregor RJ, Lindblad M. Intraoperative assessment of the curative potential to predict survival after gastric cancer resection: A national cohort study. Scand J Surg 2024; 113:109-119. [PMID: 38102973 DOI: 10.1177/14574969231216594] [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: 12/17/2023]
Abstract
BACKGROUND The surgeon's intraoperative assessment of the curative potential of tumor resection following gastrectomy adds new information that could help clinicians and patients by predicting survival. METHODS All patients in Sweden undergoing gastric cancer resection between 2006 and 2018 were grouped according to a prospectively registered variable; the surgeon's intraoperative assessment of the curative potential of surgery: curative, borderline curative, or palliative. Factors affecting group allocation were analyzed with multivariable logistic regression, while survival was analyzed using multivariable Cox regression and the Kaplan-Meier method. Positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS Of 2341 patients undergoing gastric cancer resection, 1547 (71%) were deemed curative, 340 (15%) borderline curative, and 314 (14%) palliative (140 missing assessments). Advanced stage increased the risk of borderline curative resection (Stage III, odds ratio (OR) = 6.04, 95% confidence interval (CI) = 3.92-9.31), as did emergency surgery OR = 3.31 (1.74-6.31) and blood loss >500 mL; OR = 1.63 (1.06-2.49). Neoadjuvant chemotherapy and multidisciplinary team (MDT) discussion both decreased the risk of borderline curative resection, OR = 0.58 (0.39-0.87) and 0.57 (0.40-0.80), respectively. In multivariable Cox regression, the surgeon's assessment independently predicted worse survival for borderline curative (hazard ratio (HR) = 1.54, 95% CI = 1.29-1.83) and palliative resections (HR = 1.76, 95% CI = 1.45-2.19), compared to curative resections. The sensitivity of the surgeon's assessment of long-term survival was 96.7%. The PPV was 50.7% and the NPV was 92.1%. CONCLUSION The surgeon's intraoperative assessment of the curative potential of gastric cancer surgery may independently aid survival prediction and is analogous to prognostication by pathologic Staging. Advanced disease, emergency surgery, and a high intraoperative blood loss, increases the risk of a borderline curative or palliative resection. Conversely, neoadjuvant treatment and MDT discussion reduce the risk of borderline curative or palliative resection.
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Affiliation(s)
- Gustav Linder
- Department of Surgical Sciences Uppsala University Ingång 70, 1 tr SE-751 85 Uppsala Sweden
| | - Richard J McGregor
- Clinical Surgery, The University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Mats Lindblad
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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2
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Steyn PF, Karusseit O. Gastric perforation biopsy: is it obsolete? Langenbecks Arch Surg 2024; 409:139. [PMID: 38676744 PMCID: PMC11055769 DOI: 10.1007/s00423-024-03325-9] [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: 11/21/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The aim of the study was to test the established hypothesis that biopsies of spontaneous gastric perforations should be taken to rule out cancer. METHODS A prospective observational study was performed. Consecutive patients with spontaneous gastric perforation were included. Biopsies of the edges of the perforation were submitted for histological evaluation. The epithelial type as well as the nature of the pathology were evaluated. RESULTS Sixty-eight patients were included. Eight (12%) biopsies revealed duodenal origin. Sixty (88%) biopsies revealed gastric mucosa of which 33 (48%) could be specifically typed. All biopsies revealed benign ulceration. No malignancies were detected in these biopsies or on subsequent gastroscopic follow up. CONCLUSION This study suggests that routine intraoperative biopsy of gastric perforation may be questioned. Biopsy is probably better performed endoscopically after recovery.
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Affiliation(s)
- Petre Francois Steyn
- Department of Surgery, University of Pretoria Medical School, Pretoria, South Africa
| | - Otto Karusseit
- Department of Surgery, University of Pretoria Medical School, Pretoria, South Africa.
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3
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Wang YL, Chan XW, Chan KS, Shelat VG. Omental patch repair of large perforated peptic ulcers ≥25 mm is associated with higher leak rate. J Clin Transl Res 2021; 7:759-766. [PMID: 34988327 PMCID: PMC8710357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND AND AIM Omental patch repair is the present gold-standard technique for patients with perforated peptic ulcers (PPUs). Data are lacking regarding the safe ulcer size for omental patch repair leak (OPL). We analyze our experience in managing PPU to identify an ulcer size cut-off for predicting OPL. METHODS Patients who had undergone omental patch repair for PPU between Jan 2004 and Apr 2016 were included. Demographic data, the American Society of Anesthesiologists score, ulcer size, operative approach, post-operative complications, and length of stay were recorded. OPL, intra-abdominal collection, repeat surgery, and 30-day mortality were recorded. The relationship between ulcer size, pre-operative characteristics, and OPL were investigated with univariate and multivariate logistic regression. Receiver operating characteristic curve analysis derived the ulcer size cut-off to predict OPL. In addition, we analyzed if ulcer size predicted mortality or malignancy. RESULTS Six hundred and ninety patients with a mean age of 55.1 years (range 16-94) were managed for PPU during the study period. Free air on X-ray was evident in 417 (60.4%) patients. Mean ulcer size was 7.8 mm (range 1-50). OPL occurred in 15 patients (2.2%) and 30-day mortality was 7.4% (n=51). Multivariate analysis found ulcer size increase of 10 mm (OR 3.30, 95% CI 1.81-6.02, P<0.001) predicted increased risk of OPL. At 25 mm cut-off, sensitivity was 26.7%, specificity was 97.2%, positive likelihood ratio was 9.47, and negative likelihood ratio was 0.76 for OPL. CONCLUSION Ulcer size increase in 10 mm increases leak rate by 3.3 times. Ulcer size ≥25 mm predicts OPL. RELEVANCE FOR PATIENTS Increased risk of OPL for ≥25 mm warrants need for close post-operative monitoring and lowers threshold for investigations in event of clinical deterioration. Decision for omental patch repair versus gastrectomy however should not be based on ulcer size alone.
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Affiliation(s)
- Yi Liang Wang
- 1Department of General Surgery, Khoo Teck Puat Hospital, Singapore
| | - Xue Wei Chan
- 2Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Kai Siang Chan
- 2Department of General Surgery, Tan Tock Seng Hospital, Singapore
- Corresponding author Kai Siang Chan Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore. E-mail:
| | - Vishal G. Shelat
- 2Department of General Surgery, Tan Tock Seng Hospital, Singapore
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4
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Moala AlHazmi R, Nasrallah Alfaraj D, Nasser AlNaimi S, Mohammed AlQahtani S, Hamed AlJuwayed M, Mohammed Zakriea H, Foula MS. A Rare Presentation of Gastric Carcinoma With Gastric Perforation and Septic Shock. Cureus 2021; 13:e18657. [PMID: 34765382 PMCID: PMC8575344 DOI: 10.7759/cureus.18657] [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] [Accepted: 10/10/2021] [Indexed: 12/16/2022] Open
Abstract
Perforated viscus is a fatal condition associated with a high mortality rate that necessitating immediate management. In gastric cancer, perforation is a relatively late rare presentation. In this study, we report a case of a 40-year-old male who presented with perforated gastric cancer. In the emergency department (ED), the provisional diagnosis was septic peritonitis and shock. However, upon exploratory laparotomy, pyloric tumor was detected metastasizing to the duodenum, liver, and porta hepatis.
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Affiliation(s)
- Reem Moala AlHazmi
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Dunya Nasrallah Alfaraj
- Emergency Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Shaykhah Nasser AlNaimi
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Sarah Mohammed AlQahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Mashael Hamed AlJuwayed
- Radiology, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Hazem Mohammed Zakriea
- General Surgery, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU
| | - Mohammed S Foula
- General Surgery, Imam Abdulrahman Bin Faisal University, King Fahd University Hospital, Dammam, SAU
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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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6
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Sugase T, Michiura T, Urabe S, Sasaki K, Hayashi N, Yamabe K. Optimal treatment and complications of patients with the perforated upper gastrointestinal tract. Surg Today 2021; 51:1446-1455. [PMID: 33608745 DOI: 10.1007/s00595-021-02247-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition. METHODS This was a retrospective, single-center study conducted between 2010 and 2019. We analyzed 50 patients with intraperitoneal free air caused by peptic ulcer (44 cases) or cancer (six cases). RESULTS All patients initially received either conservative therapy (n = 7) or surgery (n = 43). The nonsurgically cured patients were significantly younger and had mild peritonitis and also had a shorter hospital stay. Two patients were converted to surgery due to worsening symptoms, and one of them was elderly and had a long perforation-to-treatment time. Regarding postoperative complications, patients with Grade II-V (n = 21) were significantly older and had a poorer physical status, longer perforation-to-surgery time, and higher preoperative CRP and lactate than those with Grade 0-I (n = 24). Multivariable analyses identified elevated preoperative lactate as an independent risk factor for postoperative complications. The patients with noncurative surgery for perforated advanced gastric cancer all died within 1 year after surgery. CONCLUSIONS Consideration should be given to the nonsurgical indications in elderly and delayed treatment patients and the postoperative outcomes of patients with preoperatively elevated lactate levels.
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Affiliation(s)
- Takahito Sugase
- Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan.
| | - Toshiya Michiura
- Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan
| | - Shoichiro Urabe
- Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan
| | - Kazuki Sasaki
- Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan
| | - Nobuyasu Hayashi
- Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan
| | - Kazuo Yamabe
- Department of Surgery, Kinan Hospital, 46-70 Shinjo, Tanabe, Wakayama, 646-8588, Japan
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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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8
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Kazi M, Shrikhande SV, Chaudhari VA, Kurunkar S, Bhandare MS. Emergency Radical Gastrectomy with Pancreatico-duodenectomy for a Recent Onset Perforation of Locally Advanced Gastric Cancer with Pancreatic Head Involvement-Exceptional but a Definite Option. Indian J Surg Oncol 2020; 11:278-281. [PMID: 33364719 DOI: 10.1007/s13193-020-01189-1] [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: 01/25/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022] Open
Abstract
Gastric cancer perforations are rare events with management options ranging from lavage and perforation closure, to resection. Usual aim is to perform a damage control procedure, and very few patients are suitable for a curative resection. We report the first case of emergency gastrectomy with pancreatico-duodenectomy performed in emergency for a perforated stomach cancer with pancreatic head invasion. The patient was a 32-year-old gentleman who presented with a perforated antro-pyloric cancer with infiltration of pancreatic head. Emergency radical gastrectomy with en-bloc pancreatico-duodenectomy was performed with due considerations to the patient and disease factors. He had an uneventful postoperative recovery and remains disease free at 18 months of follow-up after having received adjuvant chemotherapy. Curative resections should be selectively offered in advanced (T4b) gastric cancers in patients without multiple adverse factors. In an emergency situation with perforation peritonitis, if the magnitude of resection is deemed unlikely to add to significant morbidity of the surgery, taking multiple factors into consideration, an R0 resection can offer a large survival benefit in such settings.
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Affiliation(s)
- Mufaddal Kazi
- Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Vikram A Chaudhari
- Department Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra 400012 India
| | - Sagar Kurunkar
- Apple Saraswati Multi-specialty Hospital, Kolhapur, India
| | - Manish S Bhandare
- Department Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra 400012 India
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9
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Kim HS, Lee JH, Kim MG. Outcomes of laparoscopic primary gastrectomy with curative intent for gastric perforation: experience from a single surgeon. Surg Endosc 2020; 35:4206-4213. [PMID: 32860136 DOI: 10.1007/s00464-020-07902-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/17/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Gastric cancer perforation is rare and difficult to distinguish from gastric ulcer perforation before surgery. Peritonitis caused by gastric perforation requires emergency surgery. The optimal surgical strategy for gastric perforation has not been established. MATERIAL AND METHODS Data from 43 patients who underwent primary gastrectomy with curative intent for gastric perforation between June 2010 and November 2019 were reviewed. Patients were classified into gastric ulcer and gastric cancer groups. Early surgical outcomes and overall survival were assessed. RESULTS There were no significant differences in clinical characteristics between the two groups except regarding preoperative shock. Laparoscopic gastrectomy was performed in 35 of 43 patients. There were no conversions to open surgery. The surgical findings demonstrated that the gastric cancer group had larger mass lesions with significantly larger perforations than did the gastric ulcer group. There were no significant differences in early surgical outcomes. Severe postoperative complications occurred in nine patients, five of whom died within one month of surgery. The majority of patients (90%) had stage III or IV gastric cancer. The 5-year survival rate was 19.5%. CONCLUSION We found no definitive differences in clinical characteristics distinguishing gastric cancer from ulcers. Considering our surgical outcomes, laparoscopic primary gastrectomy performed by an expert is a useful technique for emergency gastric perforation. However, unless an expert is available, caution should be used when selecting laparoscopic primary gastrectomy with curative intent as a surgical method.
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Affiliation(s)
- Hyung Suk Kim
- Department of Surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri, 471-701, Korea
| | - Jun Ho Lee
- Department of Surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri, 471-701, Korea
| | - Min Gyu Kim
- Department of Surgery, Hanyang University Guri Hospital, 153, Gyeongchun-ro, Guri, 471-701, Korea. .,Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Seoul, Korea.
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10
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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.
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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
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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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12
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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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13
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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.
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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
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14
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Gonçalves R, Saad R, Malheiros CA, Kassab P, Vieira NLP. Gastric cancer with lesion extending to spleen and perforation into free peritoneum. Rev Assoc Med Bras (1992) 2017; 63:484-487. [PMID: 28876422 DOI: 10.1590/1806-9282.63.06.484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 12/04/2016] [Indexed: 11/22/2022] Open
Abstract
Perforated gastric carcinoma is a rare condition that is hard to diagnose preoperatively. It is associated with advanced cancer stages and has a high mortality, particularly in cases presenting preoperative shock. Few studies have investigated the presentation and adequate management of these carcinomas. In addition, there are no reports in the literature on perforations extending to the spleen, as described in this case, making the management of these lesions challenging. Our article reports a case of gastric tumor perforation extending to the spleen, which presented as a perforated acute abdomen. The patient was treated with total gastrectomy and D2 lymph node resection with splenectomy and progressed well with current survival of one year at disease stage IV.
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Affiliation(s)
- Roberto Gonçalves
- MD, MSc. Department of Surgery, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
| | - Roberto Saad
- MD, PhD. Department of Surgery, FCMSCSP, São Paulo, SP, Brazil
| | | | - Paulo Kassab
- MD, PhD. Department of Surgery, FCMSCSP, São Paulo, SP, Brazil
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15
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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.
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Affiliation(s)
- Nebojsa Ignjatovic
- Clinic of General Surgery, Clinical Center Nis, Nis, Serbia School of Medicine, University of Nis, Nis, Serbia.
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16
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Serban D, Branescu C, Savlovschi C, El-Khatib A, Tudor C, Nica A, Kraft A, Dascalu AM. Complex histopathological and surgical aspects in a case of giant malignant gastric perforation. J Med Life 2016; 9:216-9. [PMID: 27453758 PMCID: PMC4863518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
We present the case of a 52-year-old male patient, hospitalized on an emergency basis in the University Emergency Hospital in Bucharest, after being diagnosed with pneumoperitoneum acute abdomen, for which emergency surgery was mandatory. A 3,5-4 cm malignant gastric perforation, ascitis and peritoneal carcinomatosis were found. The histopathological exam revealed infiltrative mucinous gastric carcinoma with epiploic metastasis. Due to the lack of available gastric material, an atypical surgical solution was performed: gastric packing with epiploic material by means of transgastric traction. The solution proved to be successful for short-term recovery. The underlying condition was not focused on, the patient being directed to the Oncology Department. Acute gastric perforation is a rare complication of gastric cancer, and the association with gastric linitis is uncommon. This specific histopathological condition made the classical surgical repair techniques unsuitable for the presented case and an atypical solution had to be performed.
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Affiliation(s)
- D Serban
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Branescu
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - C Savlovschi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A El-Khatib
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - C Tudor
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - A Nica
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A Kraft
- University Emergency Hospital, Upper Digestive Surgery Clinic, Bucharest, Romania
| | - AM Dascalu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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17
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Leeman MF, Skouras C, Paterson-Brown S. The management of perforated gastric ulcers. Int J Surg 2013; 11:322-4. [PMID: 23454244 DOI: 10.1016/j.ijsu.2013.02.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 02/13/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Perforated gastric ulcers are potentially complicated surgical emergencies and appropriate early management is essential in order to avoid subsequent problems including unnecessary gastrectomy. The aim of this study was to examine the management and outcome of patients with gastric ulcer perforation undergoing emergency laparotomy for peritonitis. METHODS Patients undergoing laparotomy at the Royal Infirmary of Edinburgh for perforated gastric ulcers were identified from the prospectively maintained Lothian Surgical Audit (LSA) database over the five-year period 2007-2011. Additional data were obtained by review of electronic records and review of case notes. RESULTS Forty-four patients (25 male, 19 female) were identified. Procedures performed were: 41 omental patch repairs (91%), 2 simple closures (4.5%) and 2 distal gastrectomies (4.5%; both for large perforations). Four perforated gastric tumours were identified (8.8%), 2 of which were suspected intra-operatively and confirmed histologically, 1 had unexpected positive histology and 1 had negative intra-operative histology, but follow-up endoscopy confirmed the presence of carcinoma (1 positive biopsy in 21 follow-up endoscopies); all 4 were managed without initial resection. Median length of stay was 10 days (range 4-68). Overall 7 patients died in hospital (15.9%) and there were 21 morbidities (54.5%). Registrars performed the majority of the procedures (16 alone, 21 supervised) with no significant difference in post-operative morbidity (P = 0.098) or mortality (P = 0.855), compared to consultants. CONCLUSION Almost all perforated gastric ulcers can be effectively managed by laparotomy and omental patch repair. Initial biopsy and follow-up endoscopy with repeat biopsy is essential to avoid missing an underlying malignancy.
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Affiliation(s)
- Matthew Fraser Leeman
- Department of Surgery, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh, United Kingdom.
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18
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Vasas P, Wiggins T, Chaudry A, Bryant C, Hughes FS. Emergency presentation of the gastric cancer; prognosis and implications for service planning. World J Emerg Surg 2012; 7:31. [PMID: 23009085 PMCID: PMC3507761 DOI: 10.1186/1749-7922-7-31] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 09/10/2012] [Indexed: 12/02/2022] Open
Abstract
Aims To compare emergency and elective presentation of gastric cancer by mode of clinical presentation, initial stage, intervention and prognosis. Methods Data were collected prospectively for all cases of gastric cancer presenting to a tertiary referral centre between 2003 and 2010. This was stratified by emergency and elective presentation and was analysed for mode of presentation, initial stage and outcome. Statistical analysis was performed using unpaired t-test and Chi2 test. Results A total of 291 patients presented: Forty-two (14.43%) were emergencies and 249 (85.57%) elective presentations. Analysis of the emergency cohort showed 25 patients presented with obstruction (59.52%), 15 presented with haematemesis (35.71%) and 2 with perforation (4.76%). Eighteen of the emergency patients (45%) presented with stage 4 disease compared to 60 (25.42%) in the elective group (p < 0.005). Fourteen of the emergency patients were treated with curative intent (33.3%) compared with 130 (55.56%) in the elective group (p < 0.01). Over 6 years only 2 patients needed operation within 24 hours of presentation. Overall survival at one year for emergency patients was 48.3% compared to 63.4% in elective patients (p < 0.05). There were no survivors from the emergency group after 3 years but 32.46% of the elective patients survived (p < 0.02). Elective presentation with disease stage 1A-3B had a two year survival rate of 54.95% compared to only 20% in the emergency group (p < 0.05). Of patients who underwent operative intervention 67.44% of patients who presented electively survived to 2 years. This compared to just 25% presenting as emergencies (p < 0.001). Conclusions Emergency presentation of gastric cancer is rare; is associated with higher stage of disease at presentation and lower rates of operability. The necessity to perform emergency operation within 24 hours is exceedingly rare. Emergency presentation is a marker of poor long term outcome for equivalent cancer stage in non-advanced (stages 1A-3B) disease.
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Affiliation(s)
- Peter Vasas
- Academic Surgical Department, Barts and the London NHS Trust, Whitechapel, London (E1 1BB), United Kingdom.
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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.
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Affiliation(s)
- Ker-Kan Tan
- Digestive Disease Centre, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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