Terayama Masayoshi, Kumagai Koshi, Ri Motonari, Makuuchi Rie, Hayami Masaru, Ida Satoshi, Ohashi Manabu, Sano Takeshi, Nunobe Souya
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
In Vivo. 2025 Mar-Apr;39(2):969-975. doi: 10.21873/invivo.13902.
BACKGROUND/AIM: Gastrectomy is often performed for perforated gastric cancer in patients receiving treatment with curative intent. However, gastrectomy is not a curative procedure, precludes oral intake, and may hinder palliative chemotherapy in patients with metastatic disease. The present study assessed the feasibility of a "stomach-preserving strategy" comprising peritoneal lavage and repair surgery for the management of gastric cancer perforation in patients with distant metastasis.
We retrospectively reviewed the medical records of patients with gastric cancer who underwent surgical treatment at our hospital from 2013 to 2021. The clinical courses of patients who had undergone peritoneal lavage and repair surgery for perforated gastric cancer with distant metastasis were reviewed to evaluate postoperative outcomes.
During the study period, 3,862 patients underwent radical gastrectomy. Additionally, nine patients with stage IV gastric cancer with distant metastasis prior to treatment underwent emergency surgery due to gastric perforation. Of the nine patients that underwent emergency surgery, seven patients underwent peritoneal lavage and repair surgery and two underwent peritoneal lavage only. No cases of secondary leakage were observed. Seven patients (78%) had a good postoperative course including the resumption of meals and continuation of chemotherapy. The remaining two died of sepsis. The median overall survival time was five months from surgery and 12 months from the initiation of palliative chemotherapy.
A "stomach-preserving strategy" for the management of perforated gastric cancer is safe in patients with stage IV gastric cancer with distant metastasis and allows continuation of oral intake and palliative chemotherapy.
背景/目的：对于接受根治性治疗的胃癌穿孔患者，常施行胃切除术。然而，胃切除术并非根治性手术，会导致无法经口进食，且可能妨碍转移性疾病患者的姑息化疗。本研究评估了一种“保留胃策略”的可行性，该策略包括腹膜灌洗和修复手术，用于治疗远处转移的胃癌穿孔患者。
我们回顾性分析了2013年至2021年在我院接受手术治疗的胃癌患者的病历。对因远处转移的胃癌穿孔而接受腹膜灌洗和修复手术的患者的临床病程进行回顾，以评估术后结局。
在研究期间，3862例患者接受了根治性胃切除术。此外，9例治疗前有远处转移的IV期胃癌患者因胃穿孔接受了急诊手术。在接受急诊手术的9例患者中，7例接受了腹膜灌洗和修复手术，2例仅接受了腹膜灌洗。未观察到二次渗漏病例。7例患者（78%）术后病程良好，包括恢复进食和继续化疗。其余2例死于败血症。从手术开始计算的中位总生存时间为5个月，从姑息化疗开始计算为12个月。
对于有远处转移的IV期胃癌患者，采用“保留胃策略”治疗胃癌穿孔是安全的，并且能够继续经口进食和进行姑息化疗。
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