[Outcomes of surgical therapy and prognostic factors in spontaneous gastric tumor perforation].

Background: The aim of the present study was to evaluate the clinicopathological features in patients with perforated gastric cancer, to point out the surgical approaches, and to analyze the factors that affect morbidity and mortality.

Methods: The data of 24 patients with perforated gastric cancer who underwent emergency intervention between 1996 and 2006 were retrospectively analyzed. The overall age was 60.6 years, and 62.5% of the patients were male.

Results: The tumor was localized at the antrum most frequently (66.7%), and stage IV disease was present in 66.7% of the patients (n = 16). Concomitant disease was present in 58.3% of the patients (n = 14). In 54.2% of patients (n = 13) primary repair and omentopexy, in 20.8% (n = 5) D0 or D1 total gastrectomy, in 8.3% (n = 2) D0 subtotal gastrectomy, in 8.3% (n = 2) D0 wedge resection, and in 8.3% (n = 2) staged D2 total gastrectomy were performed. The morbidity rate was 29.2% (n = 7) and the mortality rate was 25% (n = 6). Multivariant analysis showed that diffuse peritonitis and the period between perforation and operation (longer than 24 hours) were effective on prognosis, either on morbidity (p = 0.002 and p = 0.002, respectively) or on mortality (p = 0.009 and p = 0.000, respectively).

Conclusion: Postoperative morbidity and mortality rates are high in patients with perforated gastric cancer. In resectable cases, one-stage radical gastrectomy should be encouraged if conditions allow. In patients with diffuse peritonitis and poor general condition, palliative surgery or staged radical gastrectomy should be considered. High rates of mortality and morbidity can be reduced with early diagnosis and with the surgical control of gastric perforation before peritonitis.