Outcomes of surgical therapy and prognostic factors in spontaneous gastric tumor perforation

BACKGROUND
The aim of the present study was to evaluate the clinicopathological features in patients with perforated gastric cancer, to point out the surgical approaches, and to analyze the factors that affect morbidity and mortality.
METHODS
The data of 24 patients with perforated gastric cancer who underwent emergency intervention between 1996 and 2006 were retrospectively analyzed. The overall age was 60.6 years, and 62.5% of the patients were male.
RESULTS
The tumor was localized at the antrum most frequently (66.7%), and stage IV disease was present in 66.7% of the patients (n=16). Concomitant disease was present in 58.3% of the patients (n=14). In 54.2% of patients (n=13) primary repair and omentopexy, in 20.8% (n=5) D0 or D1 total gastrectomy, in 8.3% (n=2) D0 subtotal gastrectomy, in 8.3% (n=2) D0 wedge resection, and in 8.3% (n=2) staged D2 total gastrectomy were performed. The morbidity rate was 29.2% (n=7) and the mortality rate was 25% (n=6). Multivariant analysis showed that diffuse peritonitis and the period between perforation and operation (longer than 24 hours) were effective on prognosis, either on morbidity (p=0.002 and p=0.002, respectively) or on mortality (p=0.009 and p=0.000, respectively).
CONCLUSION
Postoperative morbidity and mortality rates are high in patients with perforated gastric cancer. In resectable cases, one-stage radical gastrectomy should be encouraged if conditions allow. In patients with diffuse peritonitis and poor general condition, palliative surgery or staged radical gastrectomy should be considered. High rates of mortality and morbidity can be reduced with early diagnosis and with the surgical control of gastric perforation before peritonitis.

Mide tümör perforasyonlarýnda cerrahi tedavi sonuçlarý ve prognostik faktörler

AMAÇ
Bu yazýda, mide tümörü perfore olan hastalarda klinik ve patolojik özellikler sunuldu, cerrahi yaklaþýmlar deðerlendirildi, mortalite ve morbiditeye etkili faktörler araþtýrýldý.
GEREÇ VE YÖNTEM
1996-2006 yýllarý arasýnda mide tümörü perforasyonu nedeniyle acil ameliyat edilen 24 hastanýn verileri retrospektif olarak incelendi. Hastalarýn %62,5’i erkek ve yaþ ortalamasý 60,6 yýl idi.
BULGULAR
Tümör en sýk (%66,7) antrum yerleþimliydi ve %66,7’sinde (n=16) hastalýk evre IV idi. Olgularýn %58,3’ünde (n=14) yandaþ hastalýk vardý. Olgularýn %54,2’sine (n=13) primer dikiþ ve omentopeksi, %20,8’ine (n=5) D0 veya D1 total gastrektomi, %8,3’üne (n=2) D0 subtotal gastrektomi, %8,3’üne (n=2) D0 kama rezeksiyon ve %8,3’üne (n=2) basamaklandýrýlmýþ cerrahiyle D2 total gastrektomi uygulandý. Olgularýn %29,2’sinde (n=7) ameliyat sonrasý morbidite, %25’inde (n=6) mortalite geliþti. Çok deðiþkenli analizlerde diffüz peritonit geliþmesinin ve ameliyata kadar geçen sürenin 24 saatten uzun olmasýnýn hem morbidite (sýrasýyla p=0,002 ve p=0,002) ve hem de mortalite geliþimine (sýrasýyla p=0,009 ve p=0,000) yönelik prognostik faktörler olduðu gösterildi.
SONUÇ
Mide tümör perforasyonlarýnýn ameliyat sonrasý morbidite ve mortalite oranlarý yüksektir. Genel durumu iyi hastalarda tümör rezektabl ise tek aþamalý radikal gastrektomi yapýlmalýdýr. Genel durumu kötü ve diffüz peritoniti olan hastalarda ise palyatif cerrahi veya basamaklandýrýlmýþ yaklaþýmla radikal gastrektomi yapýlabilir. Yüksek mortalite ve morbidite oranlarý erken tanýyla ve diffüz peritonit geliþmeden perforasyonun kontrol altýna alýnmasýyla düþürülebilir.