The best surgical approach for perforated gastric cancer: One-stage vs. two-stage gastrectomy

Tatsuo Hata, Naoaki Sakata, Katsuyoshi Kudoh, Chikashi Shibata, Michiaki Unno

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)


Background: Surgery for perforated gastric cancer has a dual purpose: treating life-threatening peritonitis and curing gastric cancer. An emergent one-stage gastrectomy may place an undue burden on patients with a poor general status and could impair long-term survival even if the gastric malignancy is curable. A two-stage gastrectomy, in which the initial treatment of peritonitis is followed by elective gastrectomy, can accomplish both desired purposes. Methods: We retrospectively analyzed 514 Japanese cases of perforated gastric cancer. 376 patients underwent a one-stage gastrectomy and 54 patients underwent a two-stage gastrectomy. We evaluated patient characteristics, surgical outcomes, postoperative complications, and survival rates in both groups. Results: The two-stage gastrectomy group saw a 78.4 % rate of curative R0 resection and 1.9 % hospital mortality rate, while corresponding rates in the one-stage gastrectomy group were 50 and 11.4 %, respectively. Among cases in which curative R0 resection was performed, there was no significant difference in overall survival between 136 one-stage gastrostomies and 40 two-stage gastrostomies. In a multivariate analysis, curative R0 resection [hazard ratio (HR) 2.937, p = 0.001] and depth of tumor invasion (HR 1.179, p = 0.016) were identified as independent prognostic factors. Conclusions: Regardless of whether patients underwent a one-stage or two-stage gastrectomy, curative R0 resection improved survival in patients with perforated gastric cancer. When curative R0 resection cannot be performed in the initial treatment phase due to diffuse peritonitis, non-curative and palliative gastrectomy should be avoided, and a two-stage gastrectomy should be planned following peritonitis recovery and detailed examinations.

Original languageEnglish
Pages (from-to)578-587
Number of pages10
JournalGastric Cancer
Issue number3
Publication statusPublished - 2014 Jul


  • Gastrectomy
  • Gastric cancer
  • Perforation

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology
  • Cancer Research


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