Perforated Gastrýc Cancer: A Dýffýcult Challenge For The Surgeon.

INTRODUCTION: Perforated gastric cancer (PGC) is a rare complication of gastric cancer that is associated with high in-hospital mortality. Most patients with PGC undergo emergency surgery with a prediagnosis of acute abdomen. The challenges faced in the preoperative diagnosis persist during surgery due to lack of an optimum surgical approach, meaning that the surgical treatment of patients with PGC is often based on the experience and prejudices of the surgeon. The aim in the present study is to evaluate the clinicopathological characteristics of patients with PGC and to discuss the currently available surgical treatment options.
METHODS: The present study investigated retrospectively the demographic characteristics of 30 patients who underwent surgery for pgc in our clinic, and in whom a pathological examination revealed adenocarcinoma. The study further evaluated the relationship between the employed treatment methods and survival.
RESULTS: The study included 30 patients, 23 of which were male and seven who were female. The mean age was 62.4±10.5 years. In terms of disease progression, 23 patients had stage IV, six had stage III and one had stage II. Of the total, 19 patients underwent a gastrectomy and 11 underwent local repair. In-hospital mortality occurred in 10 patients (four of which underwent a gastrectomy and six who underwent a local repair). The difference between the gastrectomy and local repair groups was significant in terms of mortality (p<0.017). Overall survival was 286±516.7 days across the entire study group, 421.2±614.8 days in the gastrectomy group and 68±105.7 days in the local repair group. There was a significant difference between the two groups in terms of mean survival (p<0.13). A positive correlation was identified between perioperative sepsis parameters and in-hospital mortality. The mean survival time was significantly higher in the non-septic group (886±729.5 days) than in the septic group (67.8±65.5 days) (p<0.01).
DISCUSSION AND CONCLUSION: Patients with PGC represent a challenge for surgeons due to difficulties in treatment and the poor prognosis of the patients. Although PGC occurs in only very rare occasions, it must be kept in mind that the selection of an appropriate surgical therapy and the successful treatment of sepsis are of vital importance.