Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND Perforated gastric cancer (GC) is a rare but life-threatening surgical emergency. Optimal surgical management remains controversial, and evidence from high-volume centers, especially in Western countries, is limited. AIM To evaluate surgical and survival outcomes of patients with perforated GC (PGC) according to the initial treatment strategy. METHODS A retrospective cohort study was conducted including all patients with pathologically confirmed perforated gastric adenocarcinoma treated at a single tertiary cancer center between January 2009 and March 2024. Surgical strategies were categorized as gastrectomy or primary perforation repair. Outcomes analyzed included 30- and 90-day mortality, postoperative major complications, and overall survival (OS). RESULTS Among 1586 GC patients undergoing surgical treatment, 36 (2.3%) presented with PGC. The mean age was 62.5 years, and 55% were male. American Society of Anesthesiologists (ASA) class III/IV was present in 58.3%, and 83% had stage IV disease, with distant metastasis in 50%. Perforation repair was performed in 26 patients (72.2%), while 10 (27.8%) underwent one-stage gastrectomy. ASA III/IV status (57.7% vs 30%, P = 0.260) and metastatic disease (57.7% vs 30%, P = 0.137) were more frequent in the Perforation Repair Group, though not statistically significant. This group also had a higher rate of diffuse-type and poorly differentiated tumors (P = 0.024 and P = 0.014, respectively). Thirty- and 90-day mortality were higher in the Perforation Repair Group (61.5% vs 30%, P = 0.139; and 65.4% vs 30%, P = 0.073), without significance. Three patients initially repaired were later referred for gastrectomy. OS was significantly better in the Gastrectomy Group (P = 0.002), with median survival of 8.8 months vs 0.5 months. On multivariable analysis, gastrectomy was independently associated with improved survival (P = 0.026). CONCLUSION When clinically feasible, gastrectomy—either immediate or delayed—provides superior survival compared to local perforation repair alone in patients with PGC.
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416599203