Introduction: Gastric cancer is the 4th most common malignancy and second leading cause of cancer-related death worldwide, both its incidence and mortality have decreased over the past 70 years. Advancing life expecta...Introduction: Gastric cancer is the 4th most common malignancy and second leading cause of cancer-related death worldwide, both its incidence and mortality have decreased over the past 70 years. Advancing life expectancy, as well as subtle change in the type and location of gastric cancer in the US, has resulted in an increased number of elderly patients requiring gastric surgery. By 2050, the population older than 85 years is projected to reach 20.9 million, and as a result, the need to assess the operative outcomes and mortality following gastrectomy in this group is imperative. This study sought to assess age-related clinical outcomes following gastric cancer surgery across all age groups to provide more precise data for pre-operative surgical risk stratification. Methods: Discharge data on 40,276,240 patients was collected from Nationwide Inpatient Sample Database (NIS) (2004-2008). Data on patients undergoing gastrectomy as the primary procedure was analyzed including age, gender, elective/non-elective admission, pre-operative length of stay (LOS), total LOS, and mortality. Eight age groups were compared for two procedures: total gastrectomy (TG) and partial gastrectomy (PG). Categorical data was compared using the Chi square test and continuous data using the Student’s t test. Univariate analysis and multivariate regression analysis were performed to assess independent variables. Results: 13,799 patients underwent gastrectomy surgery with 23.7% having TG and 76.3% PG. Gastric carcinoma was the most common indication for TG, while benign gastric disease was more common for PG, especially in years 51 - 70 (p ± 12.8 and 64 ± 15 years respectively. Males underwent twice the number of TGs (p p % change noted in those 41 - 50 years (1500%). PGs performed decreased overall, especially in patients 81 years with the greatest % change in the oldest patients >91 years (13%). Non-elective admissions were more common for PGs (N = 4844, 41%) than TGs (N = 695, 21.2%). Mean pre-operative LOS and total LOS increased wi展开更多
AIM:To study and assess clinical outcomes of various modes of treatment for perforated giant gastric ulcer in an emergency setting.METHODS:From May 2010 to February 2013,20cases of perforated giant gastric ulcer(>2...AIM:To study and assess clinical outcomes of various modes of treatment for perforated giant gastric ulcer in an emergency setting.METHODS:From May 2010 to February 2013,20cases of perforated giant gastric ulcer(>2 cm)were operated on in an emergency setting.All the patients presented with features of peritonitis and were resuscitated aggressively before taking for surgery.In the first4 cases,primary closure was done after taking a biopsy and among these,the 3rdcase also underwent partial distal gastrectomy and gastrojejunostomy and the 4th case underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy for malignancy.All the remaining 16 cases underwent partial distal gastrectomy and gastrojejunostomy.RESULTS:Among the first 4 cases,2 had an uneventful recovery and were discharged on the 6thpostoperative day.The 3rdand 4thpatients developed gastricfistula,leading to prolonged hospitalization.For the 3rd patient,conservative management was tried for 1 wk,followed by partial distal gastrectomy and gastrojejunostomy,and he was discharged on the 20thday after admission,while the 4thpatient underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy.Postoperatively,he developed adult respiratory distress syndrome,multiorgan dysfunction syndrome and expired on the 3rdpostoperative day of the second surgery.All the remaining 16 patients underwent partial distal gastrectomy and gastrojejunostomy and recovered well.Among these,4 of them were malignant and the remaining were benign ulcers.All had an uneventful recovery.The percentage of malignancy in our series was 30%(6 out of 20 cases).In our study,86%had an uneventful recovery,complications were seen in about 10%,and mortality was about 5%.CONCLUSION:In giant gastric ulcer,the chances of malignancy and leak after primary closure are high.So,we feel that partial distal gastrectomy and gastrojejunostomy is better.展开更多
文摘Introduction: Gastric cancer is the 4th most common malignancy and second leading cause of cancer-related death worldwide, both its incidence and mortality have decreased over the past 70 years. Advancing life expectancy, as well as subtle change in the type and location of gastric cancer in the US, has resulted in an increased number of elderly patients requiring gastric surgery. By 2050, the population older than 85 years is projected to reach 20.9 million, and as a result, the need to assess the operative outcomes and mortality following gastrectomy in this group is imperative. This study sought to assess age-related clinical outcomes following gastric cancer surgery across all age groups to provide more precise data for pre-operative surgical risk stratification. Methods: Discharge data on 40,276,240 patients was collected from Nationwide Inpatient Sample Database (NIS) (2004-2008). Data on patients undergoing gastrectomy as the primary procedure was analyzed including age, gender, elective/non-elective admission, pre-operative length of stay (LOS), total LOS, and mortality. Eight age groups were compared for two procedures: total gastrectomy (TG) and partial gastrectomy (PG). Categorical data was compared using the Chi square test and continuous data using the Student’s t test. Univariate analysis and multivariate regression analysis were performed to assess independent variables. Results: 13,799 patients underwent gastrectomy surgery with 23.7% having TG and 76.3% PG. Gastric carcinoma was the most common indication for TG, while benign gastric disease was more common for PG, especially in years 51 - 70 (p ± 12.8 and 64 ± 15 years respectively. Males underwent twice the number of TGs (p p % change noted in those 41 - 50 years (1500%). PGs performed decreased overall, especially in patients 81 years with the greatest % change in the oldest patients >91 years (13%). Non-elective admissions were more common for PGs (N = 4844, 41%) than TGs (N = 695, 21.2%). Mean pre-operative LOS and total LOS increased wi
文摘AIM:To study and assess clinical outcomes of various modes of treatment for perforated giant gastric ulcer in an emergency setting.METHODS:From May 2010 to February 2013,20cases of perforated giant gastric ulcer(>2 cm)were operated on in an emergency setting.All the patients presented with features of peritonitis and were resuscitated aggressively before taking for surgery.In the first4 cases,primary closure was done after taking a biopsy and among these,the 3rdcase also underwent partial distal gastrectomy and gastrojejunostomy and the 4th case underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy for malignancy.All the remaining 16 cases underwent partial distal gastrectomy and gastrojejunostomy.RESULTS:Among the first 4 cases,2 had an uneventful recovery and were discharged on the 6thpostoperative day.The 3rdand 4thpatients developed gastricfistula,leading to prolonged hospitalization.For the 3rd patient,conservative management was tried for 1 wk,followed by partial distal gastrectomy and gastrojejunostomy,and he was discharged on the 20thday after admission,while the 4thpatient underwent a radical subtotal gastrectomy with D2 lymphadenectomy and gastrojejunostomy.Postoperatively,he developed adult respiratory distress syndrome,multiorgan dysfunction syndrome and expired on the 3rdpostoperative day of the second surgery.All the remaining 16 patients underwent partial distal gastrectomy and gastrojejunostomy and recovered well.Among these,4 of them were malignant and the remaining were benign ulcers.All had an uneventful recovery.The percentage of malignancy in our series was 30%(6 out of 20 cases).In our study,86%had an uneventful recovery,complications were seen in about 10%,and mortality was about 5%.CONCLUSION:In giant gastric ulcer,the chances of malignancy and leak after primary closure are high.So,we feel that partial distal gastrectomy and gastrojejunostomy is better.
