Free perforation of gastric carcinoma. Results of surgical treatment
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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.