THÁI ĐỘ XỬ TRÍ VÀ KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT UNG THƯ DẠ DÀY THỦNG

Abstract

Aims of study: 1. Evaluation of surgical  choice (one stage or two stage gastrectomy) for gastric cancer perforation.2.The surgical results of gastric cancer perforation. Patient and method: Retrospective study. Results: There were 35 patients. male 28; female 7, sex ration 4:1; mean age 65,2.Medical history: Gastroduodenal ulcer 11,4%; Closure gastroduodenal ulcer perforation 11,4%;  gastroduodenal anastomosis for gastric outlet obstruction due to gastric cancer 5,7%; Suture of gastric cancer perforation in 1; Others in 2 patients. Clinical feature: Violent and diffuse abdominal pain in 74,3%;  Abdominal pain with fever in 2 patients; pain with digestive bleeding in 5/35 patients.  Abdominal Xray revealed free air under diaphragm 68,6%; CT Scan showed free air and intraabdominal liquid in 22/35 patients; abscesses located at greater curvature in 1 patient; Free air in lesser sac in 1 patient.Gastroduodenalscopy revealed gastric cancer prior perforation in 40% + Emergency opreration in 74,3%; Elective operation in 25,7%. Operation time:  ≤ 24 h in 62,86%; > 24 h in 37,14%; in 9  other patients that perforation eroded to adjacent  organs. The location of perforation: middle part of stomach 8,6%; proximal  part of stomach  in 5,7%, distal  part of stomach in 85,7%. Average diameter of perforation: 2,386 cm; The average diameter of tumor: 6,45 cm. Complicated rate: 17,1% (6/35), Death rate: 2,9% (1/35).(on the 8nd day post  subtotal gastrectomy due to  pulmonary thrombosis). Conclusion: Gastric cancer perforation usually occurs in patient with a mean age of 65 years (65,2 years in our series). Preoperative diagnosis of malignancy accounted for 30-40% (40% in our series); perforation located at distal stomach about 80% (85,7% in our series); Stage III-IV more than 60% (68,6% in our series).  Emergency one- stage gastrectomy had significantly lower rates of R0 resection and D2 lymph node dissection than two-stage gastrectomy. One- stage gastrectomy should be chosen for perforated gastric cancer patients with out comorbidities, localized peritonitis, no signs of shock, curable tumor. The treatment choice seems to be radical total or subtotal gastrectomy with associated D2-D3 lymphadenectomy. For patients in poor condition, two- stage surgical treatment is  a better option when D2 radical gastrectomy cannot be achieved in emmergency surgery. Two stage gastrectomy may be a promissing procedure for perforated gastric cancer patients. Simple repaire or omental patch are reserved only for reserved only for patients with advanced stage diseases and whose general condition is poor.