Original Article

Emergency gastric cancer: Are there any differences between indications, morbidity, and mortality?


Tolga Kalayci1, Umit Haluk Iliklerden2

1Erzurum Regional Education and Research Hospital, Erzurum, Turkey
2Van Yuzuncu Yil University Faculty of Medicine, Van, Turkey


Abstract


Background: Gastric cancer is a major health problem all over the world. Primary treatment is decided according to the algorithms after the evaluation of the tumoral stage. But, routine algorithms cannot be applied in emergency conditions. Patients are cured with suitable emergency treatment methods. This study aims to evaluate the differences between emergency surgery groups, and to find the factor(s) affecting morbidity and mortality in gastric cancer patients operated in emergency situations.
Methods: Patients who had been operated in our clinic because of gastric cancer between 2010 and 2018 were chosen retrospectively. Gastrectomy cases applied due to emergency conditions (severe bleeding, perforation, or gastric outlet obstruction) were filtered. The effect(s) of preoperative, intraoperative, and postoperative parameters on morbidity and mortality was evaluated and the differences between emergency surgery groups were searched. A p-value below 0.05 was considered statistically significant.
Results: The mean age of 61 patients was 61.9 years (27-89) and the male/female ratio was 4.5. The most commonly seen American Society of Anesthesiologists Classification (ASA) score was ASA 2 (n=20, 32.7%). The indications of emergency gastric cancer surgery are divided into three categories: Gastric outlet obstruction (GOO), severe bleeding that required surgery, and perforation. The most common emergency surgery indication was GOO (n=30, 49.1%). The most common tumor localization was antrum (n=34, 55.8%). ASA score (p = <0.001), tumor localization (p = <0.001), type of surgery (p = 0.015), the number of drains placed in the abdominal cavity (p = 0.001), pathology of gastrectomy specimen (p = 0.006), anastomotic leak rate (p = 0.043), morbidity rates (p = 0.014), and mortality rates (p = 0.017) were statistically different between the groups. Morbidity and mortality rates of the study were 59% (n=36) and 24.6% (n=15), respectively. Morbidity was affected by emergency surgery indication (p=0.0
Conclusions: Surgery for emergency gastric cancer has higher morbidity and mortality than elective cases. Emergency conditions should be diagnosed as soon as possible to reduce morbidity and mortality. In addition, as few drains as possible should be placed during surgery to reduce morbidity. Besides, screening programs should be expanded for early diagnosis of gastric cancer.

Keywords: gastric cancer; gastric outlet obstruction; morbidity; mortality; perforation