Manara Michele, Aiolfi Alberto, Wang Quan, Bonitta Gianluca, Shabat Galyna, Biondi Antonio, Calì Matteo, Bona Davide, Bonavina Luigi
I.R.C.C.S. Ospedale Galeazzi-Sant'Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, 20122 Milan, Italy.
I.R.C.C.S. Policlinico San Donato, Division of General and Foregut Surgery, Department of Biomedical Sciences for Health, University of Milan, 20122 Milano, Italy.
J Clin Med. 2025 Jun 29;14(13):4603. doi: 10.3390/jcm14134603.
: The optimal surgical management of perforated gastric cancer (PGC) in emergency settings remains controversial. Urgent upfront one-stage gastrectomy (1SG) and two-stage gastrectomy (2SG) with damage-control surgery followed by elective gastrectomy have been proposed. The aim of the present systematic review is to compare short- and long-term outcomes between 1SG and 2SG in the treatment of PGC. : A systematic review and individual patient data (IPD) meta-analysis of studies reporting data of patients undergoing 1SG vs. 2SG for PGC was conducted. The time-dependent effects of surgical interventions were assessed using a likelihood ratio test. Hazard function plots were generated via marginal prediction. : Ten retrospective series (579 patients) were included. Overall, 482 patients (83%) underwent 1SG, while 97 patients (17%) were treated with 2SG. A trend toward better short-term oncological outcomes and safety profiles for 2SG compared to 1SG was observed. Long-term outcomes were comparable between 1SG and 2SG, and the IPD meta-analysis showed no statistically significant difference between the two approaches in terms of OS or hazard for mortality at all time points. A trend towards a higher hazard for mortality was observed for 1SG in the first 20 months postoperatively. : Our analysis suggests that 1SG and 2SG yield comparable short-term outcomes, although 2SG may be associated with a lower medium-term mortality risk. Further research is needed to identify key factors to improve clinical judgments and decision-making in PGC.
急诊情况下穿孔性胃癌（PGC）的最佳手术治疗方案仍存在争议。有人提出了紧急一期全胃切除术（1SG）和损伤控制手术加择期全胃切除术的二期全胃切除术（2SG）。本系统评价的目的是比较1SG与2SG治疗PGC的短期和长期疗效。：对报告PGC患者接受1SG与2SG治疗数据的研究进行了系统评价和个体患者数据（IPD）荟萃分析。使用似然比检验评估手术干预的时间依赖性效应。通过边际预测生成风险函数图。：纳入了10个回顾性系列研究（579例患者）。总体而言，482例患者（83%）接受了1SG，而97例患者（17%）接受了2SG治疗。观察到与1SG相比，2SG在短期肿瘤学疗效和安全性方面有更好的趋势。1SG和2SG的长期疗效相当，IPD荟萃分析显示，在总生存期（OS）或所有时间点的死亡风险方面，两种方法之间无统计学显著差异。术后前20个月，1SG的死亡风险有升高趋势。：我们的分析表明，1SG和2SG的短期疗效相当，尽管2SG可能与较低的中期死亡风险相关。需要进一步研究以确定改善PGC临床判断和决策的关键因素。
