Di Carlo Sara, Franceschilli Marzia, Rossi Piero, Cavallaro Giuseppe, Cardi Maurizio, Vinci Danilo, Sibio Simone
Department of Surgery, Minimally Invasive Unit, University of Rome "Tor Vergata", Rome, Italy.
Department of Surgical Sciences, University of Rome "Tor Vergata", Minimally Invasive Unit, Tor Vergata Hospital, Rome, Italy.
Discov Oncol. 2021 May 15;12(1):15. doi: 10.1007/s12672-021-00410-z.
Gastric cancer perforation is a life-threatening condition that accounts for less than 5% of all gastric cancer patients and typically requires emergency surgery. However, preoperative diagnosis is difficult and management has a dual purpose: to treat peritonitis and to achieve a curative resection. The optimal surgical strategy is still unclear and prognosis remains poor. A search of the literature was performed using MEDLINE databases (Pubmed, EMBASE, Web of Science and Cochrane) using terms such as "perforated gastric cancer", "perforated gastric cancer and surgery", "perforated gastric tumour" and "gastric cancer perforated". Case reports, other reviews, non-english written papers and papers written before 2010 were excluded. Eight articles published between 2010 and 2020 matched the inclusion criteria for this review. Perforated gastric cancer was more prevalent in elderly males. Distal stomach was most frequently involved. Preoperative diagnosis was uncommon. Mortality rates ranged from 2 to 46%. Patients able to receive an R0 resection demonstrated better long-term survival compared with patients who had simple closure procedures. Laparoscopic procedure was mentioned only in one study. In an emergency situation, curative RO resection should always be offered in patients without multiple adverse factors. A surgical strategy using laparoscopic local repair as first step of surgery to resolve the peritonitis followed by a radical open or laparoscopic gastrectomy with lymphadenectomy could be considered. A balance between emergency and oncological needs should drive the surgical choice on a case by case basis.
胃癌穿孔是一种危及生命的情况，在所有胃癌患者中占比不到5%，通常需要急诊手术。然而，术前诊断困难，治疗有双重目的：治疗腹膜炎并实现根治性切除。最佳手术策略仍不明确，预后仍然很差。使用MEDLINE数据库（PubMed、EMBASE、Web of Science和Cochrane），以“穿孔性胃癌”、“穿孔性胃癌与手术”、“穿孔性胃肿瘤”和“胃癌穿孔”等术语进行文献检索。排除病例报告、其他综述、非英文撰写的论文以及2010年以前撰写的论文。2010年至2020年发表的八篇文章符合本综述的纳入标准。穿孔性胃癌在老年男性中更为常见。胃远端最常受累。术前诊断并不常见。死亡率在2%至46%之间。能够接受R0切除的患者与接受单纯闭合手术的患者相比，长期生存率更高。仅在一项研究中提到了腹腔镜手术。在紧急情况下，对于没有多种不利因素的患者，应始终提供根治性R0切除。可以考虑采用腹腔镜局部修复作为手术第一步以解决腹膜炎，随后进行根治性开放或腹腔镜胃切除术及淋巴结清扫的手术策略。应根据具体情况，在紧急需求和肿瘤治疗需求之间取得平衡，从而推动手术选择。
