title: Clinicopathological features, surgical management, and disease outcome of perforated gastric cancer.
abstract: OBJECTIVE
  Perforated gastric cancer is rare and generally not diagnosed preoperatively or intraoperatively, if a frozen section is unavailable. Therefore, the elucidation of its clinicopathological features and disease outcomes will help surgeons manage perforated gastric cancer.
  
  
  METHODS
  The clinicopathological features, surgical management, and disease outcomes of 13 patients with perforated gastric cancer from March 1989 to May 2003 were retrospectively analyzed. Disease outcomes were analyzed in-depth based on tumor stage, depth of tumor invasion, operative curability, and three treatment groups.
  
  
  RESULTS
  All 13 patients (median age of 72 years) received emergent laparotomy. Malignant gastric perforation was diagnosed intraoperatively in eight (61.5%) patients. Four patients whose frozen sections exhibited perforated gastric cancer underwent radical surgery with curative intent and were assigned to Group 1. Another four patients with overt distal metastases underwent palliative surgery and were assigned to Group 2. The remaining five patients were misdiagnosed as having benign gastric perforation and underwent local surgery; these patients were assigned to Group 3. All patients received follow-up for a median of 26 months. The survival rates for Stage I disease (P = 0.0342), T1/T2 tumors (P = 0.0342), and curative resection (P = 0.0012) significantly exceeded those of Stage III/IV, T3/T4 tumors, and non-curative resection. Additionally, the survival rates of Group 1 (P = 0.0067) and Group 3 (P = 0.0067) significantly exceeded those of Group 2. Stepwise logistic regression analysis revealed no significant predictor of prognosis.
  
  
  CONCLUSIONS
  In resectable cases, one-stage radical gastrectomy with possible extensive lymphadenectomy should be encouraged if conditions allow. In cases of misdiagnosis, non-radical local surgery with curative resection is sufficient to treat early-stage cancer.
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China. jowsc@adm.cgmh.org.tw
authors.forename: Shyh-Chuan
authors.initials: SC
authors.lastname: Jwo
authors.forename: Rong-Nan
authors.initials: RN
authors.lastname: Chien
authors.forename: Tzu-Chien
authors.initials: TC
authors.lastname: Chao
authors.forename: Huang-Yang
authors.initials: HY
authors.lastname: Chen
authors.forename: Chin-Yew
authors.initials: CY
authors.lastname: Lin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D013270:Stomach / Q000293:injuries*; D013274:Stomach Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome