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Updated: Jan 9, 2026
Laparoscopy-endoscopy Cooperative Surgery for the Treatment of Gastric Gastrointestinal Stromal Tumors
Published on: February 19, 2022
Surgical treatment of perforated gastric tumors
Matheus Felipe Ferreira Aguiar1, Marina Alessandra Pereira1, Andre Roncon Dias1
1Department of Gastroenterology, Instituto do Cancer, Instituto do Cancer, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01249000, Brazil.
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.
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