Perforated gastric cancer: a critical appraisal

Abstract

Gastric cancer perforation is a life-threatening condition that accounts for less than 5% of all gastric cancer patients and typically requires emergency surgery. However, preoperative diagnosis is difficult and management has a dual purpose: to treat peritonitis and to achieve a curative resection. The optimal surgical strategy is still unclear and prognosis remains poor. A search of the literature was performed using MEDLINE databases (Pubmed, EMBASE, Web of Science and Cochrane) using terms such as “perforated gastric cancer”, “perforated gastric cancer and surgery”, “perforated gastric tumour” and “gastric cancer perforated”. Case reports, other reviews, non-english written papers and papers written before 2010 were excluded. Eight articles published between 2010 and 2020 matched the inclusion criteria for this review. Perforated gastric cancer was more prevalent in elderly males. Distal stomach was most frequently involved. Preoperative diagnosis was uncommon. Mortality rates ranged from 2 to 46%. Patients able to receive an R0 resection demonstrated better long-term survival compared with patients who had simple closure procedures. Laparoscopic procedure was mentioned only in one study. In an emergency situation, curative RO resection should always be offered in patients without multiple adverse factors. A surgical strategy using laparoscopic local repair as first step of surgery to resolve the peritonitis followed by a radical open or laparoscopic gastrectomy with lymphadenectomy could be considered. A balance between emergency and oncological needs should drive the surgical choice on a case by case basis.

Laparoscopic versus Open Total Gastrectomy for Locally Advanced Gastric Cancer: Short and Long-Term Results

“…The set-up of medium volume centers specializing in laparoscopic abdominal surgery and experienced in enhanced recovery programs seems the key factor for the successful development of such an LG program. Number of complications, including fistulas was low; however, mortality was also very low in this series, highlighting the importance of the multidisciplinary setting and expertise of highly specialized units [ 75 , 76 , 77 ].…”

Effectiveness of conservative treatment for upper gastrointestinal perforation in older patients aged >70 years: a single-center retrospective study

“…In this study, we compared the effectiveness of conservative treatment with that of surgical treatment in patients of the same age. The most common cause of upper gastrointestinal perforation is peptic ulcers, with other causes including cancer, diverticulum, foreign bodies, iatrogenic procedure, and trauma [7][8][9][10][11].…”

Gastric perforation biopsy: is it obsolete?

“…The practice of perforation biopsies dates from the pre-endoscopic era in which histological diagnoses before and/or after non-resectional surgery were necessarily unknown [ 18 , 19 ]. Because gastric cancer can penetrate and perforate the gastric wall, the concern of missing a malignancy was always present [ 20 ]. This concern was incidentally addressed by the practice of performing definitive ulcer surgery for perforation [ 21 ].…”