Perforated gastric carcinoma: a report of 10 cases and review of the literature

Roviello, Franco; Rossi, Símone; Marrelli, Daniele; Manzoni, Giovanni De; Pedrazzani, Corrado; Morgagni, Paolo; Corso, Giovanni; Pinto, Enrico

doi:10.1186/1477-7819-4-19

Cited by 82 publications

(38 citation statements)

References 18 publications

(16 reference statements)

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“…Even in the presence of concurrent peritonitis, patients with perforated gastric cancer should undergo gastric resection; the only exception to this recommendation occurs when a patient is hemodynamically unstable or has unresectable cancer [131-133]. …”

Section: Introductionmentioning

confidence: 99%

2013 WSES guidelines for management of intra-abdominal infections

Sartelli

Viale

Catena³

et al. 2013

World J Emerg Surg

271

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Section: Introductionmentioning

confidence: 99%

2013 WSES guidelines for management of intra-abdominal infections

Sartelli

Viale

Catena³

et al. 2013

World J Emerg Surg

271

267

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“…This bleeding ulcer was successfully under-run at a peripheral hospital prior to definitive gastrectomy at our centre once the diagnosis of adenocarcinoma had been confirmed. Perforation of gastric cancer is also rare with a reported incidence rate of 0.3-3% of all cases of gastric carcinoma [6-8]. …”

Section: Discussionmentioning

confidence: 99%

“…Perforated gastric cancer is rare accounting for 0.3-3% of gastric cancer cases [6-8], but gastric cancer is present in 10-16% of patients presenting with gastric perforation [9]. Only one-third of cases of perforated gastric cancer are diagnosed pre-operatively [7].…”

Section: Introductionmentioning

confidence: 99%

Emergency presentation of the gastric cancer; prognosis and implications for service planning

et al. 2012

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AimsTo compare emergency and elective presentation of gastric cancer by mode of clinical presentation, initial stage, intervention and prognosis.MethodsData were collected prospectively for all cases of gastric cancer presenting to a tertiary referral centre between 2003 and 2010. This was stratified by emergency and elective presentation and was analysed for mode of presentation, initial stage and outcome. Statistical analysis was performed using unpaired t-test and Chi2 test.ResultsA total of 291 patients presented: Forty-two (14.43%) were emergencies and 249 (85.57%) elective presentations. Analysis of the emergency cohort showed 25 patients presented with obstruction (59.52%), 15 presented with haematemesis (35.71%) and 2 with perforation (4.76%).Eighteen of the emergency patients (45%) presented with stage 4 disease compared to 60 (25.42%) in the elective group (p < 0.005). Fourteen of the emergency patients were treated with curative intent (33.3%) compared with 130 (55.56%) in the elective group (p < 0.01). Over 6 years only 2 patients needed operation within 24 hours of presentation.Overall survival at one year for emergency patients was 48.3% compared to 63.4% in elective patients (p < 0.05). There were no survivors from the emergency group after 3 years but 32.46% of the elective patients survived (p < 0.02). Elective presentation with disease stage 1A-3B had a two year survival rate of 54.95% compared to only 20% in the emergency group (p < 0.05). Of patients who underwent operative intervention 67.44% of patients who presented electively survived to 2 years. This compared to just 25% presenting as emergencies (p < 0.001).ConclusionsEmergency presentation of gastric cancer is rare; is associated with higher stage of disease at presentation and lower rates of operability. The necessity to perform emergency operation within 24 hours is exceedingly rare. Emergency presentation is a marker of poor long term outcome for equivalent cancer stage in non-advanced (stages 1A-3B) disease.

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“…One patient experienced perforation 4 weeks after therapy start with repeated interruptions of treatment as described before. Histopathological analysis of the resected specimens showed poorly differentiated tumors with transmural infiltration in both cases which is regarded to be a negative prognostic factor [26]. These findings may argue that the primary tumors were the reason for the perforations, but final determination was impossible.…”

Section: Discussionmentioning

confidence: 99%

Phase I study of imatinib, cisplatin and 5-fluoruracil or capecitabine in advanced esophageal and gastric adenocarcinoma

et al. 2012

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BackgroundDespite all benefit provided by established therapies prognosis of gastric cancer remains poor. Targeted inhibition of platelet derived growth factor receptor (PDGFR) by imatinib may influence tumor growth and amplify chemotherapeutic effects.MethodsThis phase I study evaluated dose limiting toxicity (DLT) of imatinib combinated with chemotherapy according to a 3-patient cohort dose-escalating design. Thirty-five patients received cisplatin (60 mg/m2 d1 q 3w)/ capecitabine (1250 mg/m2 bid d1-14 q 21) or cisplatin (50 mg/m2 d1 q 2w)/ 5-fluoruracil (2 g/m2 d1, q 1w). Imatinib was started d - 4 with dose escalation from 300 to 700 mg QD in 100 mg steps.ResultsAt imatinib dose level 1 (300mg) one DLT was observed, three more patients were enrolled without further DLT. At dose level 5 (700 mg) two gastric perforations occurred, so 600 mg imatinib emerged as the maximum tolerated dose. Major grade 3/4 toxicities were nausea (6%), anemia (6%) and fatigue (3%). Response evaluation revealed partial response in 27% and stable disease in 43% of the assessable patients.ConclusionsCombination of imatinib and chemotherapy is well tolerated. Response rates were not superior to those of standard therapy. Further investigations of a larger group of patients are required to confirm the amplification of chemotherapy effects by imatinib.Trial registrationEuropean Clinical Trials Database: Eudra-CT2006-005792-17 and Clinical Trials Database: NCT00601510

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Perforated gastric carcinoma: a report of 10 cases and review of the literature

Cited by 82 publications

References 18 publications

2013 WSES guidelines for management of intra-abdominal infections

2013 WSES guidelines for management of intra-abdominal infections

Emergency presentation of the gastric cancer; prognosis and implications for service planning

Phase I study of imatinib, cisplatin and 5-fluoruracil or capecitabine in advanced esophageal and gastric adenocarcinoma

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