Dottorato in MEDICINA TRASLAZIONALE E ONCOLOGIA

Titolo della tesi: Cancer Risk in Gastro-Duodenal Perforations

Gastro-duodenal perforation is a life-threatening complication traditionally associated with benign peptic ulcer disease (PUD). However, a significant proportion of gastric and, less commonly, duodenal perforations may occur in the setting of underlying malignancy. The distinction between benign and malignant perforation carries profound diagnostic, prognostic, and therapeutic implications.While the majority of duodenal perforations are benign, related to Helicobacter pylori infection or nonsteroidal anti-inflammatory drug (NSAID) use, a notable minority of gastric perforations—ranging between 2% and 10% of cases—are secondary to gastric carcinoma. ns is therefore essential for appropriate intraoperative management, postoperative follow-up, and long-term surveillance.We conduct a retrospective review of patients with gastroduodenal perforation (GDP) at the Hospital Santa Rosa of Viterbo, from January 2022 to October 2025.A total of 43 patients were admitted with GPD (29M/14F).Emergency surgery was performed in 40 patients (93%) and a Non operative Management (NOM) in 3 patients (7%).The following were carried out 37 (92.5%) of post-operative gastroscopy between 6-8 week after the surgery, with aresponse of 6 (16.2%) gastric tumors (gastric adenocarcinoma).We performed a two stage gastrectomy in 3 patients with a D2 partial gastrectomy. We performed an intraoperative biopsy in 3 patients (3/40). 16According to 2020 WSES guidelines every gastric perforation— ulcer above 2 cm, particularly in older patients,should be considered potentially malignant until proven otherwise. It remains very challenging to perform intraoperative biopsies.Although current guidelines are increasingly moving toward recommending a two-stage surgical approach for perforated ulcers suspected of malignant neoplasia—both to stabilize the patient and to allow the initiation of neoadjuvant medical therapy—our findings show that it is difficult to determine the malignancy of the lesionintraoperatively, unless clear signs of cancer are present.