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Tuncer A, Kayaalp C. Balancing emergency repair and oncological safety in gastric ulcer perforations. World J Gastrointest Surg 2025; 17(10): 110382 [PMID: 41178851 DOI: 10.4240/wjgs.v17.i10.110382]
World J Gastrointest Surg. Oct 27, 2025; 17(10): 110382 Published online Oct 27, 2025. doi: 10.4240/wjgs.v17.i10.110382
Balancing emergency repair and oncological safety in gastric ulcer perforations
Adem Tuncer, Cuneyt Kayaalp
Adem Tuncer, Department of Surgery and Liver Transplantation, Faculty of Medicine, Istanbul Aydın University, Istanbul 34280, Türkiye
Cuneyt Kayaalp, Department of Gastroenterology Surgery, Atlas University, Istanbul 44280, Türkiye
Author contributions: Tuncer A and Kayaalp C read the original published article and discussed, designed, and wrote this letter.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Cuneyt Kayaalp, Professor, Department of Gastroenterology Surgery, Atlas University, 4/2 Gulden Street, Goztepe, Kadikoy, Istanbul 44280, Türkiye. cuneytkayaalp@hotmail.com
Received: June 5, 2025 Revised: July 10, 2025 Accepted: August 13, 2025 Published online: October 27, 2025 Processing time: 141 Days and 11.5 Hours
Abstract
Several issues should be considered before the surgical treatment of gastric ulcer perforations, including morbidity, mortality, and recurrence. However, an often-overlooked issue is determining the cause of the perforation. When the perforation is secondary to an underlying and undiagnosed malignancy, stomach resection inadequately treats the oncological disease and may increase postoperative morbidity and require re-surgery.
Core Tip: Gastric ulcer perforations are not always benign. The possibility of malignancy should not be overlooked during emergency repair. Early endoscopy following simple closure can help avoid unnecessary radical surgery while allowing timely cancer diagnosis. Additional studies are needed to determine the earliest time that endoscopy can be performed safely following peptic ulcer perforation repair.
