Emergency Radical Gastrectomy with Pancreatico-duodenectomy for a Recent Onset Perforation of Locally Advanced Gastric C
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CASE REPORT
Emergency Radical Gastrectomy with Pancreatico-duodenectomy for a Recent Onset Perforation of Locally Advanced Gastric Cancer with Pancreatic Head Involvement—Exceptional but a Definite Option Mufaddal Kazi 1 & Shailesh V. Shrikhande 2 & Vikram A. Chaudhari 3 & Sagar Kurunkar 4 & Manish S. Bhandare 3 Received: 25 January 2020 / Accepted: 19 August 2020 # Indian Association of Surgical Oncology 2020
Abstract Gastric cancer perforations are rare events with management options ranging from lavage and perforation closure, to resection. Usual aim is to perform a damage control procedure, and very few patients are suitable for a curative resection. We report the first case of emergency gastrectomy with pancreatico-duodenectomy performed in emergency for a perforated stomach cancer with pancreatic head invasion. The patient was a 32-year-old gentleman who presented with a perforated antro-pyloric cancer with infiltration of pancreatic head. Emergency radical gastrectomy with en-bloc pancreatico-duodenectomy was performed with due considerations to the patient and disease factors. He had an uneventful postoperative recovery and remains disease free at 18 months of follow-up after having received adjuvant chemotherapy. Curative resections should be selectively offered in advanced (T4b) gastric cancers in patients without multiple adverse factors. In an emergency situation with perforation peritonitis, if the magnitude of resection is deemed unlikely to add to significant morbidity of the surgery, taking multiple factors into consideration, an R0 resection can offer a large survival benefit in such settings. Keywords Gastric cancer . Perforated . Gastro-whipple’s . Pancreatico-duodenectomy
Introduction
Case Description
Perforation in gastric cancer is a rare event occurring in less than 1% of the patients [1]. The pancreas is most frequent organ involved in T4b gastric cancers, especially in distal tumors [2, 3]. The combination of perforated gastric cancer with pancreatic invasion is a much rare event, and to the best of our knowledge, no reports mention of the same being treated in a curative manner with combined gastrectomy and pancreatico-duodenectomy. We report the first such case with favorable outcomes and provide rationale for management.
A 32-year-old gentleman with no co-morbidities presented with complaints of epigastric pain and vomiting of 1-month duration associated with weight loss and anorexia. Performance status of the patient in the Eastern Co-operative Oncology Group (ECOG) scale was 1. Other than epigastric fullness, physical examination was unremarkable. Upper GI endoscopy was performed 4 days after presentation that showed an ulcerative growth in the pylorus extending into 1st part of duodenum. A naso-jejunal tube was placed during the same procedure for nutritional rehabilitation as the patient had partial gastric outlet obstruction. Biopsy from the growth was reported as moderately differentiated adenocarcinoma. A contrast-enhanced CT scan was performed of abdomen and pelvis which re
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