Abstract
Gastric oncologic surgical emergencies typically manifest as perforated or bleeding gastric carcinoma and gastric outlet obstruction. Generally, acute care surgeons should utilize treatment strategies like those for complicated peptic ulcer disease. In this chapter, we briefly review gastric adenocarcinoma, cancer-specific stomach anatomy, and typical presentations of gastric oncologic emergencies. Treatment strategies for perforated and bleeding gastric cancer, including repair, resection, endoscopic therapy, and angioembolization, are reviewed in detail. Finally, this chapter concludes with a discussion on the optimal management of malignant gastric outlet obstruction and palliative care for advanced cases.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021;71:7–33.
Vasas P, Wiggins T, Chaudry A, Bryant C, Hughes FS. Emergency presentation of the gastric cancer; prognosis and implications for service planning. World J Emerg Surg. 2012;7:31.
Markar SR, Mackenzie H, Jemal S, Faiz O, Cunningham D, Hanna GB. Emergency presentation of esophagogastric cancer. Ann Surg. 2018;267:711–5.
Blackshaw GRJC, Stephens MR, Lewis WG, Paris HJ, Barry JD, Edwards P, Allison MC. Prognostic significance of acute presentation with emergency complications of gastric cancer. Gastric Cancer. 2004;7:91–6.
Islami F, Ward EM, Sung H, et al. Annual Report to the Nation on the Status of Cancer, Part 1: National Cancer Statistics. J Natl Cancer Inst. 2021;113(12):1648–69.
Bornschein J, Selgrad M, Warnecke M, Kuester D, Wex T, Malfertheiner P. H. pylori infection is a key risk factor for proximal gastric cancer. Digest Dis Sci. 2010;55:3124–31.
Wroblewski LE, Peek RM, Wilson KT. Helicobacter pylori and gastric cancer: factors that modulate disease risk. Clin Microbiol Rev. 2010;23:713–39.
Lunet N, Valbuena C, Vieira AL, Lopes C, Lopes C, David L, Carneiro F, Barros H. Fruit and vegetable consumption and gastric cancer by location and histological type: case–control and meta-analysis. Eur J Cancer Prev. 2007;16:312–27.
Ladeiras-Lopes R, Pereira AK, Nogueira A, Pinheiro-Torres T, Pinto I, Santos-Pereira R, Lunet N. Smoking and gastric cancer: systematic review and meta-analysis of cohort studies. Cancer Cause Control. 2008;19:689–701.
Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396:635–48.
Oliveira C, Pinheiro H, Figueiredo J, Seruca R, Carneiro F. Familial gastric cancer: genetic susceptibility, pathology, and implications for management. Lancet Oncol. 2015;16:e60–70.
van der Post RS, Oliveira C, Guilford P, Carneiro F. Hereditary gastric cancer: what’s new? Update 2013–2018. Fam Cancer. 2019;18:363–7.
van der Post RS, Vogelaar IP, Carneiro F, et al. Hereditary diffuse gastric cancer: updated clinical guidelines with an emphasis on germline CDH1 mutation carriers. J Med Genet. 2015;52:361–74.
Siewert JR, Stein HJ. Classification of adenocarcinoma of the oesophagogastric junction. Br J Surg. 1998;85:1457–9.
Network NCC Gastric Cancer (Version 5.2021). https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed 1 Nov 2021.
Cutsem EV, Sagaert X, Topal B, Haustermans K, Prenen H. Gastric cancer. Lancet. 2016;388:2654–64.
Correa P. Gastric cancer overview. Gastroenterol Clin N. 2013;42:211–7.
Axon A. Symptoms and diagnosis of gastric cancer at early curable stage. Best Pract Res Clin Gastroenterol. 2006;20:697–708.
Kasakura Y, Ajani JA, Mochizuki F, Morishita Y, Fujii M, Takayama T. Outcomes after emergency surgery for gastric perforation or severe bleeding in patients with gastric cancer. J Surg Oncol. 2002;80:181–5.
Kotan C, Sumer A, Baser M, Kızıltan R, Carparlar MA. An analysis of 13 patients with perforated gastric carcinoma: a surgeon’s nightmare? World J Emerg Surg. 2008;3:17.
Gertsch P, Yip SKH, Chow LWC, Lauder IJ. Free perforation of gastric carcinoma: results of surgical treatment. Arch Surg-chicago. 1995;130:177–81.
Wu F-H, Chiang R-A, Tsai Y-C, Hung S-T, Huang S-S. Perforated gastric carcinoma in a young-age patient. J Cancer Res Pract. 2018;5:74–6.
Jwo S, Chien R, Chao T, Chen H, Lin C. Clinicopathological features, surgical management, and disease outcome of perforated gastric cancer. J Surg Oncol. 2005;91:219–25.
Roviello F, Rossi S, Marrelli D, Manzoni GD, Pedrazzani C, Morgagni P, Corso G, Pinto E. Perforated gastric carcinoma: a report of 10 cases and review of the literature. World J Surg Oncol. 2006;4:19.
Adachi Y, Mori M, Maehara Y, Matsumata T, Okudaira Y, Sugimachi K. Surgical results of perforated gastric carcinoma: an analysis of 155 Japanese patients. Am J Gastroenterol. 1997;92:516–8.
Ergul E, Gozetlik EO. Emergency spontaneous gastric perforations: ulcus versus cancer. Langenbecks Arch Surg. 2009;394:643–6.
Williams WO. Gastric carcinoma and acute perforation. Br Med J. 1952;1:164.
Bhaskar S, Kumari P, Sinha DK. Incidence of malignancy in gastric/antral perforation. Int Surg J. 2019;6:3347–52.
Melloni M, Bernardi D, Asti E, Bonavina L. Perforated gastric cancer: a systematic review. J Laparoendosc Adv Surg Tech A. 2020;30:156–62.
Fisher BW, Fluck M, Young K, Shabahang M, Blansfield J, Arora TK. Urgent surgery for gastric adenocarcinoma: a study of the national cancer database. J Surg Res. 2020;245:619–28.
Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis. 2016;62:e1–e50.
Sartelli M, Chichom-Mefire A, Labricciosa FM, et al. The management of intra-abdominal infections from a global perspective: 2017 WSES guidelines for management of intra-abdominal infections. World J Emerg Surg. 2017;12:29.
Gupta S, Kaushik R, Sharma R, Attri A. The management of large perforations of duodenal ulcers. BMC Surg. 2005;5:15.
Ozmen M, Zulfikaroglu B, Kece C, Aslar A, Ozalp N, Koc M. Factors influencing mortality in spontaneous gastric tumour perforations. J Int Med Res. 2001;30:180–4.
Mahar AL, Brar SS, Coburn NG, Law C, Helyer LK. Surgical management of gastric perforation in the setting of gastric cancer. Gastric Cancer. 2012;15:146–52.
Kasakura Y, Ajani JA, Fujii M, Mochizuki F, Takayama T. Management of perforated gastric carcinoma: a report of 16 cases and review of world literature. Am Surg. 2002;68:434–40.
Lehnert T, Buhl K, Dueck M, Hinz U, Herfarth C. Two-stage radical gastrectomy for perforated gastric cancer. Eur J Surg Oncol. 2000;26:780–4.
Hata T, Sakata N, Kudoh K, Shibata C, Unno M. The best surgical approach for perforated gastric cancer: one-stage vs. two-stage gastrectomy. Gastric Cancer. 2014;17:578–87.
Sanabria A, Villegas MI, Uribe CHM. Laparoscopic repair for perforated peptic ulcer disease. Cochrane Database Syst Rev. 2013;2:CD004778.
Cirocchi R, Soreide K, Saverio SD, Rossi E, Arezzo A, Zago M, Abraha I, Vettoretto N, Chiarugi M. Meta-analysis of perioperative outcomes of acute laparoscopic versus open repair of perforated gastroduodenal ulcers. J Trauma Acute Care. 2018;85:417–25.
Fox JG, Hunt PS. Management of acute bleeding gastric malignancy. Aust N Z J Surg. 1993;63:462–5.
Sheibani S, Kim JJ, Chen B, Park S, Saberi B, Keyashian K, Buxbaum J, Laine L. Natural history of acute upper GI bleeding due to tumours: short-term success and long-term recurrence with or without endoscopic therapy. Aliment Pharmacol Ther. 2013;38:144–50.
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG clinical guideline: upper gastrointestinal and ulcer bleeding. Am J Gastroenterol. 2021;116:899–917.
Odutayo A, Desborough MJR, Trivella M, et al. Restrictive versus liberal blood transfusion for gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials. Lancet Gastroenterol Hepatol. 2017;2:354–60.
Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage. J Trauma Acute Care. 2017;82:605–17.
Kim Y, Choi IJ, Cho S, Lee JY, Kim CG, Kim M, Ryu KW, Kim Y, Park YI. Outcome of endoscopic therapy for cancer bleeding in patients with unresectable gastric cancer. J Gastroenterol Hepatol. 2013;28:1489–95.
Karita M, Tada M. Endoscopic and histologic diagnosis of submucosal tumors of the gastrointestinal tract using combined strip biopsy and bite biopsy. Gastrointest Endosc. 1994;40:749–53.
Graham DY, Schwartz JT, Cain GD, Gyorkey F. Prospective evaluation of biopsy number in the diagnosis of esophageal and gastric carcinoma. Gastroenterology. 1982;82:228–31.
Wang HH, Jonasson JG, Ducatman BS. Brushing cytology of the upper gastrointestinal tract. Obsolete or not? Acta Cytol. 1991;35:195–8.
Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112:212–39.
Wang Y-K, Kuo F-C, Liu C-J, Wu M-C, Shih H-Y, Wang SS, Wu J-Y, Kuo C-H, Huang Y-K, Wu D-C. Diagnosis of Helicobacter pylori infection: current options and developments. World J Gastroenterol. 2015;21:11221–35.
Wright CL, Kelly JK. The use of routine special stains for upper gastrointestinal biopsies. Am J Surg Pathol. 2006;30:357–61.
Kim Y-I, Choi IJ. Endoscopic management of tumor bleeding from inoperable gastric cancer. Clin Endosc. 2015;48:121–7.
Elmunzer BJ, Young SD, Inadomi JM, Schoenfeld P, Laine L. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 2008;103:2625–32.
Koh KH, Kim K, Kwon DH, et al. The successful endoscopic hemostasis factors in bleeding from advanced gastric cancer. Gastric Cancer. 2013;16:397–403.
Tsujimoto H, Hiraki S, Sakamoto N, et al. Outcome after emergency surgery in patients with a free perforation caused by gastric cancer. Exp Ther Med. 2010;1:199–203.
Lee HJ, Shin JH, Yoon H-K, Ko G-Y, Gwon D-I, Song H-Y, Sung K-B. Transcatheter arterial embolization in gastric cancer patients with acute bleeding. Eur Radiol. 2009;19:960–5.
Cho SB, Hur S, Kim H-C, Jae HJ, Lee M, Kim M, Kim J-E, Lee JH, Chung JW. Transcatheter arterial embolization for advanced gastric cancer bleeding: a single-center experience with 58 patients. Medicine. 2020;99:e19630.
Kondoh C, Shitara K, Nomura M, Takahari D, Ura T, Tachibana H, Tomita N, Kodaira T, Muro K. Efficacy of palliative radiotherapy for gastric bleeding in patients with unresectable advanced gastric cancer: a retrospective cohort study. BMC Palliat Care. 2015;14:37.
Lee J, Byun HK, Koom WS, Lee YC, Seong J. Efficacy of radiotherapy for gastric bleeding associated with advanced gastric cancer. Radiat Oncol. 2021;16:161.
Kim MM, Rana V, Janjan NA, Das P, Phan AT, Delclos ME, Mansfield PF, Ajani JA, Crane CH, Krishnan S. Clinical benefit of palliative radiation therapy in advanced gastric cancer. Acta Oncol. 2009;47:421–7.
Asakura H, Hashimoto T, Harada H, Mizumoto M, Furutani K, Hasuike N, Matsuoka M, Ono H, Boku N, Nishimura T. Palliative radiotherapy for bleeding from advanced gastric cancer: is a schedule of 30 Gy in 10 fractions adequate? J Cancer Res Clin. 2011;137:125–30.
Blumenthaler AN, Ikoma N, Blum M, Das P, Minsky BD, Mansfield PF, Ajani JA, Badgwell BD. Relationship between initial management strategy and survival in patients with gastric outlet obstruction due to gastric cancer. J Surg Oncol. 2020;122:1373–82.
Chen X-J, Chen G-M, Wei Y-C, Yu H, Wang X-C, Zhao Z-K, Luo T-Q, Nie R-C, Zhou Z-W. Palliative gastrectomy versus gastrojejunostomy for advanced gastric cancer with outlet obstruction: a propensity score matching analysis. BMC Cancer. 2021;21:188.
Haga Y, Hiki N, Kinoshita T, et al. Treatment option of endoscopic stent insertion or gastrojejunostomy for gastric outlet obstruction due to gastric cancer: a propensity score-matched analysis. Gastric Cancer. 2020;23:667–76.
Keränen I, Kylänpää L, Udd M, Louhimo J, Lepistö A, Halttunen J, Kokkola A. Gastric outlet obstruction in gastric cancer: a comparison of three palliative methods. J Surg Oncol. 2013;108:537–41.
Maetani I, Tada T, Ukita T, Inoue H, Sakai Y, Nagao J. Comparison of duodenal stent placement with surgical gastrojejunostomy for palliation in patients with duodenal obstructions caused by pancreaticobiliary malignancies. Endoscopy. 2004;36:73–8.
Jeurnink SM, van Eijck CH, Steyerberg EW, Kuipers EJ, Siersema PD. Stent versus gastrojejunostomy for the palliation of gastric outlet obstruction: a systematic review. BMC Gastroenterol. 2007;7:18.
Jeurnink SM, Steyerberg EW, van Hooft JE, van Eijck CHJ, Schwartz MP, Vleggaar FP, Kuipers EJ, Siersema PD, Group for the DSS. Surgical gastrojejunostomy or endoscopic stent placement for the palliation of malignant gastric outlet obstruction (SUSTENT study): a multicenter randomized trial. Gastrointest Endosc. 2010;71:490–9.
No JH, Kim SW, Lim C-H, Kim JS, Cho YK, Park JM, Lee IS, Choi M-G, Choi KY. Long-term outcome of palliative therapy for gastric outlet obstruction caused by unresectable gastric cancer in patients with good performance status: endoscopic stenting versus surgery. Gastrointest Endosc. 2013;78:55–62.
Fujitani K, Yamada M, Hirao M, Kurokawa Y, Tsujinaka T. Optimal indications of surgical palliation for incurable advanced gastric cancer presenting with malignant gastrointestinal obstruction. Gastric Cancer. 2011;14:353–9.
Bessoud B, de Baere T, Denys A, Kuoch V, Ducreux M, Precetti S, Roche A, Menu Y. Malignant gastroduodenal obstruction: palliation with self-expanding metallic stents. J Vasc Interv Radiol. 2005;16:247–53.
van Hooft J, van Montfoort M, Jeurnink S, Bruno M, Dijkgraaf M, Siersema P, Fockens P. Safety and efficacy of a new non-foreshortening nitinol stent in malignant gastric outlet obstruction (DUONITI study): a prospective, multicenter study. Endoscopy. 2011;43:671–5.
Huggett MT, Ghaneh P, Pereira SP. Drainage and bypass procedures for palliation of malignant diseases of the upper gastrointestinal tract. Clin Oncol. 2010;22:755–63.
Jeurnink SM, Steyerberg EW, van Hof GT, van Eijck CHJ, Kuipers EJ, Siersema PD. Gastrojejunostomy versus stent placement in patients with malignant gastric outlet obstruction: a comparison in 95 patients. J Surg Oncol. 2007;96:389–96.
Jang SH, Lee H, Min B-H, Kim SM, Kim HS, Carriere KC, Min YW, Lee JH, Kim JJ. Palliative gastrojejunostomy versus endoscopic stent placement for gastric outlet obstruction in patients with unresectable gastric cancer: a propensity score-matched analysis. Surg Endosc. 2017;31:4217–23.
Issaka RB, Shapiro DM, Parikh ND, Mulcahy MF, Komanduri S, Martin JA, Keswani RN. Palliative venting percutaneous endoscopic gastrostomy tube is safe and effective in patients with malignant obstruction. Surg Endosc. 2014;28:1668–73.
Wollman B, D’Agostino HB. Percutaneous radiologic and endoscopic gastrostomy: a 3-year institutional analysis of procedure performance. Am J Roentgenol. 1997;169:1551–3.
Yuan Y, Zhao Y, Xie T, Hu Y. Percutaneous endoscopic gastrostomy versus percutaneous radiological gastrostomy for swallowing disturbances. Cochrane Database Syst Rev. 2016;2016:CD009198.
Lee MJ, Saini S, Brink JA, Morrison MC, Hahn PF, Mueller PR. Malignant small bowel obstruction and ascites: not a contraindication to percutaneous gastrostomy. Clin Radiol. 1991;44:332–4.
Harada K, Zhao M, Shanbhag N, Baba H, Ajani JA. Palliative care for advanced gastric cancer. Expert Rev Anticancer. 2020;20:575–80.
Fuchs CS, Tomasek J, Yong CJ, et al. Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet. 2014;383:31–9.
Kang JH, Lee SI, Lim DH, et al. Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol. 2012;30:1513–8.
Thuss-Patience PC, Kretzschmar A, Bichev D, Deist T, Hinke A, Breithaupt K, Dogan Y, Gebauer B, Schumacher G, Reichardt P. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer—a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer. 2011;47:2306–14.
Hallissey MT, Allum WH, Fielding JWL, Roginski C. Palliative surgery for gastric cancer. Cancer. 1988;62:440–4.
Dittmar Y, Rauchfuss F, Goetz M, Jandt K, Scheuerlein H, Heise M, Settmacher U. Non-curative gastric resection for patients with stage 4 gastric cancer—a single center experience and current review of literature. Langenbecks Arch Surg. 2012;397:745–53.
Kim DY, Joo JK, Park YK, Ryu SY, Kim YJ, Kim SK, Lee JH. Is palliative resection necessary for gastric carcinoma patients? Langenbecks Arch Surg. 2008;393:31–5.
Lasithiotakis K, Antoniou SA, Antoniou GA, Kaklamanos I, Zoras O. Gastrectomy for stage IV gastric cancer. a systematic review and meta-analysis. Anticancer Res. 2014;34:2079–85.
Sun J, Song Y, Wang Z, Chen X, Gao P, Xu Y, Zhou B, Xu H. Clinical significance of palliative gastrectomy on the survival of patients with incurable advanced gastric cancer: a systematic review and meta-analysis. BMC Cancer. 2013;13:577.
Lim S, Muhs BE, Marcus SG, Newman E, Berman RS, Hiotis SP. Results following resection for stage IV gastric cancer; are better outcomes observed in selected patient subgroups? J Surg Oncol. 2007;95:118–22.
Fujitani K, Yang H-K, Mizusawa J, et al. Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomised controlled trial. Lancet Oncol. 2016;17:309–18.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Simpson, J.T., Pointer, D.T., Taghavi, S. (2023). Stomach. In: Tarasconi, A., Bui, S., Chirica, M., Roth, G., Nahmias, J. (eds) Oncologic Surgical Emergencies. Hot Topics in Acute Care Surgery and Trauma. Springer, Cham. https://doi.org/10.1007/978-3-031-36860-8_5
Download citation
DOI: https://doi.org/10.1007/978-3-031-36860-8_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-36859-2
Online ISBN: 978-3-031-36860-8
eBook Packages: MedicineMedicine (R0)