Optimal treatment and complications of patients with the perforated upper gastrointestinal tract
Purpose The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition. Methods This was a retrospective, single-center study conducted between 201...
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| Veröffentlicht in: | Surgery today (Tokyo, Japan) Japan), 2021-09, Vol.51 (9), p.1446-1455 |
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| creator | Sugase, Takahito Michiura, Toshiya Urabe, Shoichiro Sasaki, Kazuki Hayashi, Nobuyasu Yamabe, Kazuo |
| description | Purpose
The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition.
Methods
This was a retrospective, single-center study conducted between 2010 and 2019. We analyzed 50 patients with intraperitoneal free air caused by peptic ulcer (44 cases) or cancer (six cases).
Results
All patients initially received either conservative therapy (
n
= 7) or surgery (
n
= 43). The nonsurgically cured patients were significantly younger and had mild peritonitis and also had a shorter hospital stay. Two patients were converted to surgery due to worsening symptoms, and one of them was elderly and had a long perforation-to-treatment time. Regarding postoperative complications, patients with Grade II–V (
n
= 21) were significantly older and had a poorer physical status, longer perforation-to-surgery time, and higher preoperative CRP and lactate than those with Grade 0–I (
n
= 24). Multivariable analyses identified elevated preoperative lactate as an independent risk factor for postoperative complications. The patients with noncurative surgery for perforated advanced gastric cancer all died within 1 year after surgery.
Conclusions
Consideration should be given to the nonsurgical indications in elderly and delayed treatment patients and the postoperative outcomes of patients with preoperatively elevated lactate levels. |
| doi_str_mv | 10.1007/s00595-021-02247-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2491944949</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2491944949</sourcerecordid><originalsourceid>FETCH-LOGICAL-c371t-7750cf2d36c2a13731b38bb830521409aaf3e768375a4c982d6c4fd0391de70b3</originalsourceid><addsrcrecordid>eNp9kE1LxDAQhoMo7rr6BzxIjl6qk482zVEWv2BhL3qOaZpql7apSYrorzda9ehhmBned16GB6FTAhcEQFwGgFzmGVCSinKRfeyhJeGsyGhJ2D5aguQkI1SSBToKYQdAeQlwiBaMFVAKni_R03aMba87HL3VsbdDxHqosXH92LVGx9YNAbsGj2lMYsBvbXzB8cXi0frGeR1tjacxLfhZh-hdO0QbYjt8R2oTj9FBo7tgT376Cj3eXD-s77LN9vZ-fbXJDBMkZkLkYBpas8JQTZhgpGJlVZUMcko4SK0bZkVRMpFrbmRJ68LwpgYmSW0FVGyFzufc0bvXKb2g-jYY23V6sG4KinJJJOeSy2Sls9V4F4K3jRp9YuDfFQH1RVbNZFUiq77Jqo90dPaTP1W9rf9OflEmA5sNIUnDs_Vq5yafOIT_Yj8BQZiF6Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2491944949</pqid></control><display><type>article</type><title>Optimal treatment and complications of patients with the perforated upper gastrointestinal tract</title><source>MEDLINE</source><source>SpringerNature Complete Journals</source><creator>Sugase, Takahito ; Michiura, Toshiya ; Urabe, Shoichiro ; Sasaki, Kazuki ; Hayashi, Nobuyasu ; Yamabe, Kazuo</creator><creatorcontrib>Sugase, Takahito ; Michiura, Toshiya ; Urabe, Shoichiro ; Sasaki, Kazuki ; Hayashi, Nobuyasu ; Yamabe, Kazuo</creatorcontrib><description>Purpose
The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition.
Methods
This was a retrospective, single-center study conducted between 2010 and 2019. We analyzed 50 patients with intraperitoneal free air caused by peptic ulcer (44 cases) or cancer (six cases).
Results
All patients initially received either conservative therapy (
n
= 7) or surgery (
n
= 43). The nonsurgically cured patients were significantly younger and had mild peritonitis and also had a shorter hospital stay. Two patients were converted to surgery due to worsening symptoms, and one of them was elderly and had a long perforation-to-treatment time. Regarding postoperative complications, patients with Grade II–V (
n
= 21) were significantly older and had a poorer physical status, longer perforation-to-surgery time, and higher preoperative CRP and lactate than those with Grade 0–I (
n
= 24). Multivariable analyses identified elevated preoperative lactate as an independent risk factor for postoperative complications. The patients with noncurative surgery for perforated advanced gastric cancer all died within 1 year after surgery.
Conclusions
Consideration should be given to the nonsurgical indications in elderly and delayed treatment patients and the postoperative outcomes of patients with preoperatively elevated lactate levels.</description><identifier>ISSN: 0941-1291</identifier><identifier>EISSN: 1436-2813</identifier><identifier>DOI: 10.1007/s00595-021-02247-z</identifier><identifier>PMID: 33608745</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Adult ; Age Factors ; Aged ; Biomarkers - blood ; Conservative Treatment ; Conversion to Open Surgery - methods ; Digestive System Surgical Procedures - methods ; Female ; Humans ; Intestinal Perforation - etiology ; Intestinal Perforation - mortality ; Intestinal Perforation - surgery ; Intestinal Perforation - therapy ; Lactates - blood ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Original Article ; Peptic Ulcer - complications ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms - complications ; Surgery ; Surgical Oncology ; Time Factors</subject><ispartof>Surgery today (Tokyo, Japan), 2021-09, Vol.51 (9), p.1446-1455</ispartof><rights>Springer Nature Singapore Pte Ltd. 2021</rights><rights>2021. Springer Nature Singapore Pte Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c371t-7750cf2d36c2a13731b38bb830521409aaf3e768375a4c982d6c4fd0391de70b3</citedby><cites>FETCH-LOGICAL-c371t-7750cf2d36c2a13731b38bb830521409aaf3e768375a4c982d6c4fd0391de70b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00595-021-02247-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00595-021-02247-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33608745$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sugase, Takahito</creatorcontrib><creatorcontrib>Michiura, Toshiya</creatorcontrib><creatorcontrib>Urabe, Shoichiro</creatorcontrib><creatorcontrib>Sasaki, Kazuki</creatorcontrib><creatorcontrib>Hayashi, Nobuyasu</creatorcontrib><creatorcontrib>Yamabe, Kazuo</creatorcontrib><title>Optimal treatment and complications of patients with the perforated upper gastrointestinal tract</title><title>Surgery today (Tokyo, Japan)</title><addtitle>Surg Today</addtitle><addtitle>Surg Today</addtitle><description>Purpose
The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition.
Methods
This was a retrospective, single-center study conducted between 2010 and 2019. We analyzed 50 patients with intraperitoneal free air caused by peptic ulcer (44 cases) or cancer (six cases).
Results
All patients initially received either conservative therapy (
n
= 7) or surgery (
n
= 43). The nonsurgically cured patients were significantly younger and had mild peritonitis and also had a shorter hospital stay. Two patients were converted to surgery due to worsening symptoms, and one of them was elderly and had a long perforation-to-treatment time. Regarding postoperative complications, patients with Grade II–V (
n
= 21) were significantly older and had a poorer physical status, longer perforation-to-surgery time, and higher preoperative CRP and lactate than those with Grade 0–I (
n
= 24). Multivariable analyses identified elevated preoperative lactate as an independent risk factor for postoperative complications. The patients with noncurative surgery for perforated advanced gastric cancer all died within 1 year after surgery.
Conclusions
Consideration should be given to the nonsurgical indications in elderly and delayed treatment patients and the postoperative outcomes of patients with preoperatively elevated lactate levels.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Biomarkers - blood</subject><subject>Conservative Treatment</subject><subject>Conversion to Open Surgery - methods</subject><subject>Digestive System Surgical Procedures - methods</subject><subject>Female</subject><subject>Humans</subject><subject>Intestinal Perforation - etiology</subject><subject>Intestinal Perforation - mortality</subject><subject>Intestinal Perforation - surgery</subject><subject>Intestinal Perforation - therapy</subject><subject>Lactates - blood</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Peptic Ulcer - complications</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - epidemiology</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Stomach Neoplasms - complications</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Time Factors</subject><issn>0941-1291</issn><issn>1436-2813</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LxDAQhoMo7rr6BzxIjl6qk482zVEWv2BhL3qOaZpql7apSYrorzda9ehhmBned16GB6FTAhcEQFwGgFzmGVCSinKRfeyhJeGsyGhJ2D5aguQkI1SSBToKYQdAeQlwiBaMFVAKni_R03aMba87HL3VsbdDxHqosXH92LVGx9YNAbsGj2lMYsBvbXzB8cXi0frGeR1tjacxLfhZh-hdO0QbYjt8R2oTj9FBo7tgT376Cj3eXD-s77LN9vZ-fbXJDBMkZkLkYBpas8JQTZhgpGJlVZUMcko4SK0bZkVRMpFrbmRJ68LwpgYmSW0FVGyFzufc0bvXKb2g-jYY23V6sG4KinJJJOeSy2Sls9V4F4K3jRp9YuDfFQH1RVbNZFUiq77Jqo90dPaTP1W9rf9OflEmA5sNIUnDs_Vq5yafOIT_Yj8BQZiF6Q</recordid><startdate>20210901</startdate><enddate>20210901</enddate><creator>Sugase, Takahito</creator><creator>Michiura, Toshiya</creator><creator>Urabe, Shoichiro</creator><creator>Sasaki, Kazuki</creator><creator>Hayashi, Nobuyasu</creator><creator>Yamabe, Kazuo</creator><general>Springer Singapore</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210901</creationdate><title>Optimal treatment and complications of patients with the perforated upper gastrointestinal tract</title><author>Sugase, Takahito ; Michiura, Toshiya ; Urabe, Shoichiro ; Sasaki, Kazuki ; Hayashi, Nobuyasu ; Yamabe, Kazuo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c371t-7750cf2d36c2a13731b38bb830521409aaf3e768375a4c982d6c4fd0391de70b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Biomarkers - blood</topic><topic>Conservative Treatment</topic><topic>Conversion to Open Surgery - methods</topic><topic>Digestive System Surgical Procedures - methods</topic><topic>Female</topic><topic>Humans</topic><topic>Intestinal Perforation - etiology</topic><topic>Intestinal Perforation - mortality</topic><topic>Intestinal Perforation - surgery</topic><topic>Intestinal Perforation - therapy</topic><topic>Lactates - blood</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Peptic Ulcer - complications</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - epidemiology</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Stomach Neoplasms - complications</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sugase, Takahito</creatorcontrib><creatorcontrib>Michiura, Toshiya</creatorcontrib><creatorcontrib>Urabe, Shoichiro</creatorcontrib><creatorcontrib>Sasaki, Kazuki</creatorcontrib><creatorcontrib>Hayashi, Nobuyasu</creatorcontrib><creatorcontrib>Yamabe, Kazuo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgery today (Tokyo, Japan)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sugase, Takahito</au><au>Michiura, Toshiya</au><au>Urabe, Shoichiro</au><au>Sasaki, Kazuki</au><au>Hayashi, Nobuyasu</au><au>Yamabe, Kazuo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimal treatment and complications of patients with the perforated upper gastrointestinal tract</atitle><jtitle>Surgery today (Tokyo, Japan)</jtitle><stitle>Surg Today</stitle><addtitle>Surg Today</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>51</volume><issue>9</issue><spage>1446</spage><epage>1455</epage><pages>1446-1455</pages><issn>0941-1291</issn><eissn>1436-2813</eissn><abstract>Purpose
The perforation of the upper gastrointestinal tract is still associated with a high risk of complications and mortality. We aimed to evaluate the optimal treatment and post-treatment complications for this condition.
Methods
This was a retrospective, single-center study conducted between 2010 and 2019. We analyzed 50 patients with intraperitoneal free air caused by peptic ulcer (44 cases) or cancer (six cases).
Results
All patients initially received either conservative therapy (
n
= 7) or surgery (
n
= 43). The nonsurgically cured patients were significantly younger and had mild peritonitis and also had a shorter hospital stay. Two patients were converted to surgery due to worsening symptoms, and one of them was elderly and had a long perforation-to-treatment time. Regarding postoperative complications, patients with Grade II–V (
n
= 21) were significantly older and had a poorer physical status, longer perforation-to-surgery time, and higher preoperative CRP and lactate than those with Grade 0–I (
n
= 24). Multivariable analyses identified elevated preoperative lactate as an independent risk factor for postoperative complications. The patients with noncurative surgery for perforated advanced gastric cancer all died within 1 year after surgery.
Conclusions
Consideration should be given to the nonsurgical indications in elderly and delayed treatment patients and the postoperative outcomes of patients with preoperatively elevated lactate levels.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>33608745</pmid><doi>10.1007/s00595-021-02247-z</doi><tpages>10</tpages></addata></record> |
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| identifier | ISSN: 0941-1291 |
| ispartof | Surgery today (Tokyo, Japan), 2021-09, Vol.51 (9), p.1446-1455 |
| issn | 0941-1291 1436-2813 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2491944949 |
| source | MEDLINE; SpringerNature Complete Journals |
| subjects | Adult Age Factors Aged Biomarkers - blood Conservative Treatment Conversion to Open Surgery - methods Digestive System Surgical Procedures - methods Female Humans Intestinal Perforation - etiology Intestinal Perforation - mortality Intestinal Perforation - surgery Intestinal Perforation - therapy Lactates - blood Male Medicine Medicine & Public Health Middle Aged Original Article Peptic Ulcer - complications Postoperative Complications - diagnosis Postoperative Complications - epidemiology Retrospective Studies Risk Factors Stomach Neoplasms - complications Surgery Surgical Oncology Time Factors |
| title | Optimal treatment and complications of patients with the perforated upper gastrointestinal tract |
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