Free perforation of gastric carcinoma. Results of surgical treatment.

OBJECTIVE

To define by actual standards the results of treatment of free perforation of gastric carcinoma in a consecutive number of patients treated at one institution.

DESIGN

Case series of patients with perforated adenocarcinoma of the stomach treated in Hong Kong between 1984 and 1992.

SETTING

Urban academic medical center.

PATIENTS

Thirty-four Chinese patients who were operated on for perforated gastric carcinoma. A risk scoring system was used to predict postoperative mortality. Factors with a possible influence on postoperative mortality and long-term survival were studied using univariate and multivariate analysis.

INTERVENTION

All patients underwent laparotomy, which was performed for closure of the perforation in four patients and for gastrectomy in 30.

MAIN OUTCOME MEASURES

Thirty-day mortality and survival times.

RESULTS

The 30-day mortality rate was 20%, and the median survival time was 10 months (range, 2 to 92 months). The risk score was the only significant predictor of 30-day mortality, and the pathologic TNM staging, of long-term survival.

CONCLUSIONS

A significant proportion of patients can be saved and offered good palliation with emergency gastrectomy; those likely to die can be identified before surgery.