title: Perforation of gastric cancer - What should the surgeon do?
abstract: Perforation represents a rare and severe complication of gastric cancer (GC) with a large hospital mortality (8-82%). The aim of this study is to evaluate the clinical-pathological features in patients with perforated gastric cancer (PGC) and to advise the surgical treatment options. A total of 11 patients with PGC were retrospectively reviewed among 376 consecutive cases of GC operated. The clinical-pathological features including tumor stage, survival, and the type of treatment were observed. The perforation was more frequent in stage III (8 patients) and in stage IV (3 patients), but none of the cases in stage I and II GC were observed. All the patients had serosal invasion and lymph node metastasis. Limited lymphadenectomy (D0, D1) was performed in 5 patients, and extended lymphadenectomy (D2, D3) in 3 patients. Emergency gastrectomy was performed in 8 (72.8%) patients, subtotal gastrectomy in 5 (45.5%), and total gastrectomy in 3 (27.2%) cases. Three (27.2%) patients were treated by simple closure with omental patch. The overall 30-day mortality rate was 46%. The survival rate was higher among the patients who underwent curative resection (75.77±68.88 days) than in those who underwent simple closure with omental patch (18.00±24.43 days). The difference between the treatments in these groups was significant (p < 0.05). PGC required surgical emergency. Curative resection improved long-term survival in the patients with potentially curable gastric malignancy. Unsuccessful outcomes after PGC could be attributed to the poor condition of the patients and the advanced disease stage.
authors.affiliation: Clinic of General Surgery, Clinical Center Nis, Nis, Serbia School of Medicine, University of Nis, Nis, Serbia. n.ignjat@gmail.com.
authors.forename: Nebojsa
authors.initials: N
authors.lastname: Ignjatovic
authors.forename: Dragan
authors.initials: D
authors.lastname: Stojanov
authors.forename: Miodrag
authors.initials: M
authors.lastname: Djordjevic
authors.forename: Jelena
authors.initials: J
authors.lastname: Ignjatovic
authors.forename: Daniela
authors.initials: D
authors.lastname: Benedeto Stojanov
authors.forename: Bobana
authors.initials: B
authors.lastname: Milojkovic
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology* / Q000601:surgery; D013274:Stomach Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D066231:Surgeons; D016019:Survival Analysis; D016896:Treatment Outcome