Outcome of perforated gastric cancer: Twenty years experience of one institute

Background/Aims: The aim of the present paper is to compare the clinicopathologic features of perforated gastric cancer and the effect of surgical intervention. Methodology: Twenty-seven patients with perforated gastric carcinoma underwent surgical intervention in one medical center and were retrespectively reviewed. The clinicopathologic features included age, sex, surgical treatment, ulcer depths, tumor stage, and tumor characteristics. The end point of the study was compared to the survival of different treatments. Patients with gastric cancer without perforation were enrolled randomly in a ratio of 1: 4 to compare the clinical features and long-term outcomes. Results: All patients underwent emergency surgical intervention, including gastrectomy in 17 patients, and simple closure of the perforation in 10 cases. There were no significant differences in the patients' characteristics except tumor status and staging (p=0.008 and p<0.001, respectively). The surgical mortality was also higher in those patients who underwent simple closure (40% mortality rate, p=0.047). The clinical features of 16 patients with perforated gastric cancer were compared to those of 64 patients with gastric cancer without perforation. The survival rate was not significantly different in these 2 groups and the median survival time was 17.3 months (p=0.184). However, ulcer depth was significantly greater in patients with perforation and 10 cases (62.5%) had layer of serosa involvement. Conclusions: Perforated gastric cancer usually represented at advanced stages; but gastrectomy offered a better clinical outcome. The long-term outcome in patients with perforated gastric cancer was not inferior compared to those with gastric cancer without perforation.