Outcomes of laparoscopic primary gastrectomy with curative intent for gastric perforation: experience from a single surg
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and Other Interventional Techniques
Outcomes of laparoscopic primary gastrectomy with curative intent for gastric perforation: experience from a single surgeon Hyung Suk Kim1 · Jun Ho Lee1 · Min Gyu Kim1,2 Received: 9 March 2020 / Accepted: 17 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Gastric cancer perforation is rare and difficult to distinguish from gastric ulcer perforation before surgery. Peritonitis caused by gastric perforation requires emergency surgery. The optimal surgical strategy for gastric perforation has not been established. Material and methods Data from 43 patients who underwent primary gastrectomy with curative intent for gastric perforation between June 2010 and November 2019 were reviewed. Patients were classified into gastric ulcer and gastric cancer groups. Early surgical outcomes and overall survival were assessed. Results There were no significant differences in clinical characteristics between the two groups except regarding preoperative shock. Laparoscopic gastrectomy was performed in 35 of 43 patients. There were no conversions to open surgery. The surgical findings demonstrated that the gastric cancer group had larger mass lesions with significantly larger perforations than did the gastric ulcer group. There were no significant differences in early surgical outcomes. Severe postoperative complications occurred in nine patients, five of whom died within one month of surgery. The majority of patients (90%) had stage III or IV gastric cancer. The 5-year survival rate was 19.5%. Conclusion We found no definitive differences in clinical characteristics distinguishing gastric cancer from ulcers. Considering our surgical outcomes, laparoscopic primary gastrectomy performed by an expert is a useful technique for emergency gastric perforation. However, unless an expert is available, caution should be used when selecting laparoscopic primary gastrectomy with curative intent as a surgical method. Keywords Stomach · Perforation · Ulcer · Cancer · Laparoscopy · Gastrectomy Gastric perforation is a hole in the stomach wall that allows the gastric contents to be released into the peritoneal cavity. This process rapidly leads to chemical peritonitis, which is life threatening and requires immediate surgical treatment. Both gastric ulcer and cancer are established risk factors for gastric perforation.[1] Gastric cancer causes 6–16% of gastric perforations [1–3]. In addition, gastric perforation is associated with high morbidity and mortality of up to 30% and 50%, respectively [3–5]. Despite recent advances in surgical techniques and perioperative care [6], the optimal surgical method to treat gastric * Min Gyu Kim [email protected] 1
Department of Surgery, Hanyang University Guri Hospital, 153, Gyeongchun‑ro, Guri 471‑701, Korea
Department of Surgery, Hanyang University Guri Hospital, Hanyang University School of Medicine, Seoul, Korea
2
perforation remains controversial. The primary goal of surgery is to resolve peritonitis
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