Gastric Cancer Surgery in an Emergency Setting: Insights from a Western Multicenter Cohort

Background: Gastric cancer (GC) remains a leading cause of cancer death worldwide. A subset of patients presents acutely with life-threatening complications such as perforation, obstruction, or bleeding, requiring surgery under suboptimal conditions. This multicenter Italian study aimed to explore outcomes of emergency GC surgery, identify prognostic factors, and compare survival across clinical presentations. Methods: Between 2013 and 2022, 263 GC patients presented emergently at two high-volume Italian centers. Among them, 90 patients with histologically proven adenocarcinoma who underwent emergency surgery were included. Primary outcomes were 30-day mortality and overall survival (OS). Results: Obstruction was the most frequent presentation (41.1%), followed by hemorrhage (34.4%) and perforation (24.4%). Severe complications (Clavien-Dindo ≥ 3) occurred in 28.8% of patients, and thirty-day mortality reached 13.3%. Median OS was 6.5 months. Diffuse-type GC predicted shorter OS than intestinal-type (5.5 vs. 14 months; p = 0.015). Radical surgery was performed in 63.3% of cases and was associated with superior OS compared with palliative procedures (14 vs. 4.5 months; p < 0.001). The clinical presentation did not influence survival. On exploratory multivariable analysis, advanced age and diffuse histology were associated with higher 30-day mortality, while gastric resection was associated with better OS. Conclusions: Emergency GC surgery carries high morbidity and mortality. Age, histology, and gastric resection were independent prognostic factors, whereas clinical presentation did not significantly affect survival. Early diagnosis and tailored perioperative strategies are needed to improve outcomes.