Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1423-1433
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1423
Emergency exploratory laparotomy and radical gastrectomy in patients with gastric cancer combined with acute upper gastrointestinal bleeding
Feng Kuang, Jian Wang, Bai-Qi Wang
Feng Kuang, Jian Wang, Department of Emergency, The First Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
Bai-Qi Wang, Department of Radiation Oncology, The Second Affiliated Hospital of University of South China, Hengyang 421001, Hunan Province, China
Author contributions: Wang J designed the study; Kuang F and Wang BQ performed the experiments and analyzed the data; Kuang F wrote the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was approved by Ethics Committee of The First Affiliated Hospital of the University of South China.
Informed consent statement: The data used in the study were not involved in the patients’ privacy information, so the informed consent was waived by the Ethics Committee of The First Affiliated Hospital of University of South China. All patient data obtained, recorded, and managed only used for this study, without any harm to the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Wang, MM, Attending Doctor, Department of Emergency, The First Affiliated Hospital of University of South China, No. 69 Chuanshan Road, Hengyang 421001, Hunan Province, China. wangjian13988@163.com
Received: April 6, 2023
Peer-review started: April 6, 2023
First decision: April 19, 2023
Revised: May 7, 2023
Accepted: May 24, 2023
Article in press: May 24, 2023
Published online: July 27, 2023
Abstract
BACKGROUND

Gastric cancer (GC) is a prevalent malignant tumor worldwide and ranks as the fourth leading cause of cancer-related mortality. Upper gastrointestinal bleeding (UGIB) is a frequent complication of GC. Radical gastrectomy and palliative therapy are widely used surgical procedures in the clinical management of GC. This study intends to probe the clinical efficacy and safety of radical gastrectomy and palliative therapy on the basis of exploratory laparotomy in patients with GC combined with UGIB, hoping to provide valuable information to aid patients in selecting the appropriate surgical intervention.

AIM

To investigate the clinical efficacy and safety of exploratory laparotomy + radical gastrectomy and palliative therapy in patients with GC and UGIB combined.

METHODS

A total of 89 GC patients admitted to the First Affiliated Hospital of the University of South China between July 2018 and July 2020 were selected as participants for this study. The 89 patients were divided into two groups: radical resection group (n = 46) treated with exploratory laparotomy + radical gastrectomy and Palliative group (n = 43) treated with palliative therapy. The study compared several variables between the two groups, including surgical duration, intraoperative blood transfusion volume, postoperative anal exhaust time, off-bed activity time, length of hospitalization, and incidence of complications such as duodenal stump rupture, anastomotic obstruction, and postoperative incision. Additionally, postoperative immune function indicators (including CD3+, CD4+, CD8+, CD4+/CD8+, and CD3+/HLADR+), immunoglobulin (IgG and IgM), tumor markers (CEA, CA199, and CA125), and inflammatory factors (IL-6, IL-17, and TNF-α) were assessed. The surgical efficacy and postoperative quality of life recovery were also evaluated. The patients were monitored for survival and tumor recurrence at 6 mo, 1 year, and 2 years post-surgery.

RESULTS

The results indicated that the duration of operation time and postoperative hospitalization did not differ between the two surgical procedures. However, patients in the radical resection group exhibited shorter intraoperative blood loss, anus exhaust time, off-bed activity time, and inpatient activity time than those in the Palliative group. Although there was no substantial difference in the occurrence of postoperative complications, such as duodenal stump rupture and anastomotic obstruction, between the radical resection group and Palliative group (P > 0.05), the radical resection group exhibited higher postoperative immune function indicators (including CD3+, CD4+, CD8+, etc.) and immunoglobulin levels (IgG, IgM) than the Palliative group, while tumor markers and inflammatory factors levels were lower than those in the radical resection group. Additionally, surgical efficacy, postoperative quality of life, and postoperative survival rates were higher in patients who underwent radical gastrectomy than in those who underwent palliative therapy. Moreover, the probability of postoperative tumor recurrence was lower in the radical gastrectomy group compared to the palliative therapy group, and these differences were all statistically significant (P < 0.05).

CONCLUSION

Compared to palliative therapy, exploratory laparotomy + radical gastrectomy can improve immune function, reduce the levels of tumor markers and inflammatory factors, improve surgical efficacy, promote postoperative quality of life recovery, enhance survival rates, and attenuate the probability of tumor recurrence.

Keywords: Gastric cancer, Exploratory laparotomy, Radical gastrectomy, Upper gastrointestinal bleeding, Safety

Core Tip: Gastric cancer (GC) is a prevalent digestive system malignancy that commonly results in upper gastrointestinal bleeding (UGIB). Surgery is the primary treatment modality for GC. Radical gastrectomy and palliative therapy are commonly adopted surgical procedures. This present study investigated the clinical efficacy and safety of palliative therapy and exploratory laparotomy + radical gastrectomy in patients with GC and acute UGIB. The outcomes of the study showed that exploratory laparotomy + radical gastrectomy improved surgical efficacy, enhanced survival rates, lowered the probability of tumor recurrence, and bettered the prognosis of patients.