Lehnert T, Buhl K, Dueck M, Hinz U, Herfarth C
Section of Surgical Oncology, University of Heidelberg, Heidelberg, Germany.
Eur J Surg Oncol. 2000 Dec;26(8):780-4. doi: 10.1053/ejso.2000.1003.
Perforation represents a severe complication of gastric cancer. Because it is rare, only few data are available regarding treatment and prognosis.
Patients with perforated gastric cancer were identified from two prospective registers of gastric cancer and of gastroduodenal ulcer.
Between February 1982 and June 1999 23 patients with perforated gastric cancer were treated surgically. This corresponds to only 1.8% of 1273 patients presenting with gastric cancer, but to 14% of 161 patients presenting with gastric perforation during this time period. Overall, post-operative mortality was 13% (3/23). Initially, 21 patients had palliative operations. Two patients had a potentially curative procedure at the emergency operation and one of the two died post-operatively. Another six patients had potentially curative gastrectomy at a second stage and no patient died post-operatively. The 5-year overall survival was estimated at 50% for all eight curatively-treated patients. Median survival of palliatively treated patients was 6 months.
Perforation of the stomach should raise suspicion of malignancy, particularly in elderly patients. At the time of perforation radical gastrectomy with lymphadenectomy is mostly not advised, either because a diagnosis of gastric cancer is not confirmed or because the patient's condition does not allow extended surgery. In this situation it is suggested to consider a two-stage procedure and direct the primary operation at the treatment of perforation and peritonitis. Tumour staging can be completed when the patient has recovered and a radical operation with curative intent can be planned without compromising long-term prognosis. Our observations and a review of the literature confirm that perforation of gastric cancer does not preclude long-term survival per se in a substantial number of patients.
穿孔是胃癌的一种严重并发症。由于其罕见性，关于治疗和预后的可用数据很少。
从两个胃癌和胃十二指肠溃疡的前瞻性登记册中识别出穿孔性胃癌患者。
在1982年2月至1999年6月期间，23例穿孔性胃癌患者接受了手术治疗。这仅占1273例胃癌患者的1.8%，但占该时间段内161例胃穿孔患者的14%。总体而言，术后死亡率为13%（3/23）。最初，21例患者接受了姑息性手术。2例患者在急诊手术时进行了有可能治愈的手术，其中1例术后死亡。另外6例患者在第二阶段进行了有可能治愈的胃切除术，术后无患者死亡。所有8例接受根治性治疗的患者的5年总生存率估计为50%。接受姑息性治疗患者的中位生存期为6个月。
胃穿孔应引起对恶性肿瘤的怀疑，尤其是在老年患者中。在穿孔时，大多不建议进行根治性胃切除术加淋巴结清扫术，要么是因为胃癌诊断未得到证实，要么是因为患者的病情不允许进行扩大手术。在这种情况下，建议考虑分两阶段进行手术，并将初次手术的重点放在治疗穿孔和腹膜炎上。当患者康复后可以完成肿瘤分期，并可以计划进行根治性手术而不影响长期预后。我们的观察和文献综述证实，胃癌穿孔本身并不排除相当一部分患者的长期生存。
