Two-stage radical gastrectomy for perforated gastric cancer

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.