Gastroduodenal perforation in cancer patients

Patients with advanced or metastatic cancer have compromised nutritional, metabolic, and immune conditions. Little is known about gastroduodenal perforation in cancer patients.

Data of 11 cancer patients with gastroduodenal perforation were retrospectively reviewed.

There were 2 females and 9 males with a mean (+/- s.e.) age of 56.7+/-4.7 years and a median of 55. The primary malignancies included lung cancers (3 cases), hepatocellular carcinomas (2 cases), squamous cell carcinomas of the tongue (2 cases), malignant lymphoma of the small bowel (1 case), adenocarcinoma of the pancreas (1 case), adenocarcinoma of the stomach (1 case), and acute lymphoblastic leukemia (1 case). The average duration of symptoms was 36.5+/-10.1 hours (median: 24 hours). Methods of surgical treatment included simple closure of the perforation (6 cases), truncal vagotomy and pyloroplasty (3 cases), pyloroplasty (1 case), and subtotal gastrectomy (1 case). Four patients (36.4%) had post-operative complications. The post-operative hospital mortality rate was 18.2%. One patient died of sepsis with gastrointestinal hemorrhage and 1 died of hepatic failure and respiratory failure. Pre-operative shock is the only significant factor in predicting operative mortality.

Gastroduodenal perforation occurring in cancer patients without chemotherapy had favorable short-term operative results.