Emergency presentation of the gastric cancer; prognosis and implications for service planning

Abstract

AimsTo compare emergency and elective presentation of gastric cancer by mode of clinical presentation, initial stage, intervention and prognosis.MethodsData 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.ResultsA 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).ConclusionsEmergency 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.

Perforation of gastric cancer - What should the surgeon do?

“…Once the patient recovers and the malignity is histologically confirmed, the final gastrectomy with dissection of the corresponding nodes should be planned [11]. According to other studies, the major determinants of improved survival are not only due to curative resection, but also due to TNM stage and absence of postoperative complications [5]. Several reports on PGC showed a significantly better prognosis for patients who underwent curative resection [5,3,11,18] than for those who underwent non-curative resection [3,11,18].…”

“…According to the literature, gastric ulcers, have been the main cause of gastric perforation (GP) [4], and about 10-16% of the cases are caused by GC [1,4]. Moreover, PGC accounts for less than 1% of the incidence of acute abdomen, and usually has poor outcomes [5]. It is difficult to preoperatively diagnose PGC, because its preoperative symptoms are the same as those of a perforated gastric ulcer [4].…”

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

“…However, emergency presentation is a marker of poor long-term outcomes for the equivalent cancer stage in non-metastatic (stages I-III) disease. 50 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 of underlying malignancy.…”

Gastric Cancer, Hemophilia A and Angiodysplasia - An Unreported Association with Clinical Implications in a Patient with Digestive Hemorrhage

“…Presence of upper digestive hemorrhage in a patient with gastric cancer did not preclude an oncologically safe gastrectomy but was associated with increased rates of postoperative complications (7). Furthermore, although the emergency presentation of gastric cancer (including upper digestive hemorrhage) is rare(8), however, it was associated with poor prognosis due to advanced stage at diagnosis, low resectability rates and high rates of recurrence after curative-intent surgery (8,9). Linitis plastica is a rare subset of gastric adenocarcinoma (3.2% of patients) with significantly worse prognosis (10).…”