Surgical management of gastric perforation in the setting of gastric cancer

Abstract

Background Gastric perforation is a rare presentation of gastric cancer and is thought to be a predictor of advanced disease and, thus, poor prognosis. Guidelines do not exist for the optimal management strategy. We aimed to identify, review, and summarize the literature pertaining to perforation in the setting of gastric cancer. Methods A qualitative, systematic review of the literature was performed from January 1, 1985, to January 1, 2010. Searches of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were performed using search terms related to gastric cancer surgery. Abstracts were examined by two independent reviewers and a standardized data collection tool was used to extract relevant data points. Summary tables were created.Results Nine articles were included. Perforation was reported to occur in fewer than 5% of gastric cancer patients. Preoperative diagnosis of a gastric cancer was rated and occurred in 14-57% of patients in the papers reviewed. Mortality rates for emergency gastrectomy ranged from 0 to 50% and for simple closure procedures the rates ranged from 8 to 100%. Patients able to receive an R0 gastrectomy demonstrated better long-term survival (median 75 months, 50% 5-year) compared with patients who had simple closure procedures. Conclusions Gastric cancer patients presenting with a gastric perforation demonstrate improved overall survival with an R0 resection; however, implementation of this management technique is complicated by infrequent preoperative gastric cancer diagnosis, and inability to perform an oncologic resection due to patient instability and intraabdominal contamination.

The best surgical approach for perforated gastric cancer: one-stage vs. two-stage gastrectomy

“…Tsujimoto et al [2] showed that there were no significant differences in Surgery for perforated gastric cancer 583 the recurrence rate and pattern between perforated and nonperforated gastric cancer. Several other publications also showed that peritoneal contamination due to perforation did not adversely affect survival in perforated gastric cancer [5,6,124]. Second, uneven levels of diagnosis and treatment at different centers might have affected the results of this study.…”

“…Regardless of whether one-stage or two-stage gastrectomy is employed, the most important goal of surgical treatment for perforated gastric cancer is to achieve curative R0 resection, the same as in non-perforated common gastric cancer [6]. When curative resection was possible, the median survival time was 75 months and the 5-year survival rate was about 50 % in perforated gastric cancer [6].…”

“…When curative resection was possible, the median survival time was 75 months and the 5-year survival rate was about 50 % in perforated gastric cancer [6]. Several reports on perforated gastric cancer showed a significantly better prognosis for patients who underwent curative resection than those who underwent non-curative resection [5,124,127].…”

“…At one time, emergent one-stage gastrectomies were generally performed for gastric perforation with T. Hata Á N. Sakata (&) Á K. Kudoh Á C. Shibata Á M. Unno Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan e-mail: n-sakata@surg1.med.tohoku.ac.jp diffuse peritonitis, regardless of whether the disease was benign or malignant [6]. One-stage gastrectomy, however, was found to be associated with high mortality rates (0-50 %) [6]. Moreover, sufficient lymph node dissection is difficult to achieve during an emergent surgery for perforated gastric cancer, which may impair long-term survival due to recurrence [6].…”

“…One-stage gastrectomy, however, was found to be associated with high mortality rates (0-50 %) [6]. Moreover, sufficient lymph node dissection is difficult to achieve during an emergent surgery for perforated gastric cancer, which may impair long-term survival due to recurrence [6]. In patients with a poor clinical condition, simple closure and omental patch repair is a suitable procedure.…”