Perforated early gastric cancer: uncommon and easily missed a case report and review of literature

A Perforated Gastric Carcinoma: A Single-Center Experience

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.

Surgical outcome evaluation of perforated gastric cancer: from the aspects of both acute care surgery and surgical oncology

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.