Hemorrhagic Complications in Gastric Cancer: Current Evidence and Multidisciplinary Management Strategies

Hemorrhage is a clinically important emergency in gastric cancer, occurring in an estimated 3-36% of patients (with the incidence varying substantially by disease stage, tumor morphology, and the operational definition of hemorrhage applied), and potentially becoming life-threatening within 24 h. This review synthesizes evidence from the past two decades to propose a multidisciplinary, stepwise framework for managing gastric cancer-associated bleeding. Endoscopic hemostasis remains the first-line intervention and achieves initial bleeding control in 83-92.9% of cases, although 30-day rebleeding occurs in up to 28-41%. Transcatheter arterial embolization is an important option for persistent bleeding or hemodynamic instability, with a reported clinical success of approximately 72%. Palliative radiotherapy provides effective hemostasis in 68-88.5% of cases, and a biologically effective dose (BED10) exceeding 39 Gy may improve bleeding control. Surgery should be individualized according to disease stage, resectability, physiological reserve, and treatment intent, ranging from emergency vessel ligation to curative resection. Importantly, hemostasis should be regarded not as a final endpoint but as a therapeutic bridge enabling definitive anticancer therapy. Successful bleeding control followed by systemic chemotherapy is associated with improved overall survival. Management therefore requires coordinated decision-making among gastroenterology, interventional radiology, surgery, radiation oncology, and medical oncology teams.