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

Abstract

BACKGROUND:

Surgery for perforated gastric cancer has a dual purpose: treating life-threatening peritonitis and curing gastric cancer. An emergent one-stage gastrectomy may place an undue burden on patients with a poor general status and could impair long-term survival even if the gastric malignancy is curable. A two-stage gastrectomy, in which the initial treatment of peritonitis is followed by elective gastrectomy, can accomplish both desired purposes.

METHODS:

We retrospectively analyzed 514 Japanese cases of perforated gastric cancer. 376 patients underwent a one-stage gastrectomy and 54 patients underwent a two-stage gastrectomy. We evaluated patient characteristics, surgical outcomes, postoperative complications, and survival rates in both groups.

RESULTS:

The two-stage gastrectomy group saw a 78.4% rate of curative R0 resection and 1.9% hospital mortality rate, while corresponding rates in the one-stage gastrectomy group were 50 and 11.4%, respectively. Among cases in which curative R0 resection was performed, there was no significant difference in overall survival between 136 one-stage gastrostomies and 40 two-stage gastrostomies. In a multivariate analysis, curative R0 resection [hazard ratio (HR) 2.937, p = 0.001] and depth of tumor invasion (HR 1.179, p = 0.016) were identified as independent prognostic factors.

CONCLUSIONS:

Regardless of whether patients underwent a one-stage or two-stage gastrectomy, curative R0 resection improved survival in patients with perforated gastric cancer. When curative R0 resection cannot be performed in the initial treatment phase due to diffuse peritonitis, non-curative and palliative gastrectomy should be avoided, and a two-stage gastrectomy should be planned following peritonitis recovery and detailed examinations.

• Authors: Tatsuo Hata, Naoaki Sakata, Katsuyoshi Kudoh, Chikashi Shibata, Michiaki Unno
• Journal: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association (Gastric Cancer) Vol. 17 Issue 3 Pg. 578-87 ( 2014) ISSN: 1436-3305 [Electronic] Japan
• PMID: 24122093 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Gastrectomy (methods)
• Hospital Mortality
• Humans
• Japan
• Male
• Middle Aged
• Multivariate Analysis
• Postoperative Complications (epidemiology, etiology)
• Retrospective Studies
• Stomach Neoplasms (pathology, surgery)
• Survival Rate
• Young Adult