title: Prognostic significance of acute presentation with emergency complications of gastric cancer.
abstract: BACKGROUND
  Although acute complications necessitating emergency hospital admission are well documented in patients with carcinoma of the colon, comparable data for patients with gastric carcinoma is thin. The aim of this study, therefore, was to examine the outcomes of patients presenting to hospital as acute admissions with emergency complications of previously undiagnosed gastric cancer.
  
  
  METHODS
  Three hundred consecutive patients with gastric adenocarcinoma were studied prospectively, and subdivided into two groups according to whether the patients were referred as acute emergencies ( n = 116) or as outpatients ( n = 184).
  
  
  RESULTS
  The commonest emergency complications were: abdominal pain (57%), vomiting (41%), gastrointestinal bleeding (37%), dysphagia (26%), and a palpable mass (18%). Stages of disease were significantly more advanced in patients presenting acutely (I : II : III : IV = 7 : 11 : 27 : 71) compared with patients referred via outpatients (20 : 23 : 50 : 91, Chi(2) = 3.955; DF, 1; P = 0.047). R0 gastrectomy was significantly less likely after acute presentation (23 patients; 20%) compared with patients referred via outpatients (70 patients; 38%; Chi(2) = 11.037; DF, 1; P = 0.001). Cumulative 5-year survival for patients referred acutely was 9%, compared with 22% after outpatient referral (Chi(2) = 9.11; DF, 1; P = 0.0025). Multivariate analysis revealed two factors to be significantly and independently associated with durations of survival: stage of disease (hazard ratio [HR], 1.742; 95% confidence interval [CI], 1.493-2.034; P = 0.0001) and presentation with acute complications (HR, 1.561; 95% CI, 1.151-2.117; P = 0.004).
  
  
  CONCLUSIONS
  Emergency complications of gastric cancer are a significant and independent prognostic marker of poor outcome.
authors.affiliation: Department of Surgery, Royal Gwent Hospital, Newport, NP20 2UB, UK.
authors.forename: Guy R J C
authors.initials: GR
authors.lastname: Blackshaw
authors.forename: Michael R
authors.initials: MR
authors.lastname: Stephens
authors.forename: Wyn G
authors.initials: WG
authors.lastname: Lewis
authors.forename: Holly J
authors.initials: HJ
authors.lastname: Paris
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Barry
authors.forename: Paul
authors.initials: P
authors.lastname: Edwards
authors.forename: Miles C
authors.initials: MC
authors.lastname: Allison
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010343:Patient Admission; D011379:Prognosis; D013274:Stomach Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom