Introduction: Perforation represents a severe complication of gastric cance
r. Because it is rare, only few data are available regarding treatment and
prognosis.
Methods: Patients with perforated gastric cancer were identified from two p
rospective registers of gastric cancer and of gastroduodenal ulcer.
Results: Between February 1982 and June 1999 23 patients with perforated ga
stric cancer were treated surgically. This corresponds to only 1.8% of 1273
patients presenting with gastric cancer, but to 140/a of 161 patients pres
enting with gastric perforation during this time period. Overall, post-oper
ative mortality was 13% (3/23). Initially, 21 patients had palliative opera
tions. Two patients had a potentially curative procedure at the emergency o
peration and one of the two died post-operatively. Another six patients had
potentially curative gastrectomy at a second stage and no patient died pos
t-operatively. The 5-year overall survival was estimated at 50% for all eig
ht curatively-treated patients. Median survival of palliatively treated pat
ients was 6 months.
Conclusions: Perforation of the stomach should raise suspicion of malignanc
y particularly in elderly patients. At the time of perforation radical gast
rectomy with lymphadenectomy is mostly not advised, either because a diagno
sis of gastric cancer is not confirmed or because the patient's condition d
oes not allow extended surgery. In this situation it is suggested to consid
er a two-stage procedure and direct the primary operation at the treatment
of perforation and peritonitis. Tumour staging can be completed when the pa
tient has recovered and a radical operation with curative intent can be pla
nned without compromising long-term prognosis. Our observations and a revie
w of the literature confirm that perforation of gastric cancer does not pre
clude long-term survival per se in a substantial number of patients. (C) 20
00 Harcourt Publishers Ltd.