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Results of Surgical Treatment

Philippe Gertsch, MD; Sydney K. H. Yip, MBBS, FRCS; Louis W. C. Chow, MBBS, FRCS; Ian J. Lauder, MSc, PhD

Arch Surg. 1995;130(2):177-181.

Abstract
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.

(Arch Surg. 1995;130:177-181)

Author Affiliations
From the Department of Surgery, Queen Mary Hospital, the University of Hong Kong (Drs Gertsch, Yip, and Chow), and the Department of Statistics, the University of Hong Kong (Dr Lauder).