Prognostic significance of acute presentation with emergency complications of gastric cancer

Abstract

Background. Although acute complications necessitating emergency hospital admission are well documented in patients with carcinoma of the colon, comparable data for patients with gastric carcinoma is thin. The aim of this study, therefore, was to examine the outcomes of patients presenting to hospital as acute admissions with emergency complications of previously undiagnosed gastric cancer. Methods. Three hundred consecutive patients with gastric adenocarcinoma were studied prospectively, and subdivided into two groups according to whether the patients were referred as acute emergencies (n ‫؍‬ 116) or as outpatients (n ‫؍‬ 184). Resuslts. The commonest emergency complications were: abdominal pain (57%), vomiting (41%), gastrointestinal bleeding (37%), dysphagia (26%), and a palpable mass (18%). Stages of disease were significantly more advanced in patients presenting acutely (I : II : III : IV ‫؍‬ 7 : 11 : 27 : 71) compared with patients referred via outpatients (20 : 23 : 50 : 91, 2 ‫؍‬ 3.955; DF, 1; P ‫؍‬ 0.047). R0 gastrectomy was significantly less likely after acute presentation (23 patients; 20%) compared with patients referred via outpatients (70 patients; 38%; 2 ‫؍‬ 11.037; DF, 1; P ‫؍‬ 0.001). Cumulative 5-year survival for patients referred acutely was 9%, compared with 22% after outpatient referral ( 2 ‫؍‬ 9.11; DF, 1; P ‫؍‬ 0.0025). Multivariate analysis revealed two factors to be significantly and independently associated with durations of survival: stage of disease (hazard ratio [HR], 1.742; 95% confidence interval [CI], 1.493-2.034; P ‫؍‬ 0.0001) and presentation with acute complications (HR, 1.561; 95% CI, 1.151-2.117; P ‫؍‬ 0.004). Conclusion. Emergency complications of gastric cancer are a significant and independent prognostic marker of poor outcome.

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

“…[3] Our results reinforce this as emergency patients more often presented with advanced stage disease; 45.0% of emergency patients presenting with stage IV, compared to 25.3% of elective patients (p <0.005), (Figure 1). Only 33.3% of emergency patients had resectable disease (compared to 55.6% of elective patients) (p <0.01).…”

“…Emergency presentation of gastric cancer has been shown to have an influence on overall survival, which is independent to any other factors. Blackshaw et al [3] showed that patients presenting as an emergency had a median survival of 6 months, compared to 12 months for patients referred as an outpatient. Therefore, although emergency presentation is relatively rare, it may significantly affect prognosis.…”

Management of bleeding GI tumors

“…Overall operative mortality in acute cases was 14% compared with 7% in elective cases, also a significant difference. 66 Bleeding submucosal tumors of the stomach can be resected laparoscopically in some cases. For example, in a small series of 9 patients with GI stromal tumors who presented acutely, 4 of the 9 underwent successful laparoscopic resection.…”

Role of symptoms in diagnosis and outcome of gastric cancer

“…Eight studies have assessed the prognostic value of this sing [39,40,[44][45][46][47]54] and all but one found a strong association with a very low 5-year survival rate (0%-20%) [39,44,54] and also with a very short life span (< 4 mo) [40,46] . The prognostic role of vomiting and gastro-intestinal bleeding is more controversial.…”