Gastric Cancer Perforation: Experience from a Tertiary Care Hospital

  • Bishnu Prasad Kandel Department of Surgery, Tribhuvan University Teaching Hospital,Kathmandu
  • Yogendra Singh Department of Surgery, Tribhuvan University Teaching Hospital,Kathmandu
  • Keshav Prasad Singh Department of Surgery, Tribhuvan University Teaching Hospital,Kathmandu
  • Mahesh Khakurel Department of Surgery, KIST Medical College, Kathmandu, Nepal.


Introduction: Gastric cancer perforation can occurs in advanced stage of the disease and is often
associated with a high morbidity and mortality. Peritonitis due to perforation needs emergency
laparotomy and different surgical procedures can be performed for definitive treatment. Surgical
procedures largely depend on the stage of the disease and general condition of the patient. This
study was carried out to evaluate the outcome and role of different surgical procedures in gastric
cancer perforation.

Methods: Medical record of patients with gastric perforation, who were treated during ten years
period, was reviewed retrospectively. Data regarding clinical presentation, surgical procedures,
staging and survival of patients were obtained.

Results: Features suggestive of diffuse peritonitis were evident in all cases. The majority of the
patients underwent emergency surgery except one who died during resuscitation. The majority of
patients were in stage III and stage IV. Surgical procedure includes simple closure and omental patch
in five patients, simple closure and gastrojejunostomy in nine patients, gastrectomy in six patients
and Devine’s antral exclusion in one patient. Surgical site infection was the most common (45.5%)
postoperative complication. Four patients died within one month of the surgery. Three patients who
underwent gastrectomy survived for one year and one patient survived for five years.

Conclusions: Although gastric cancer perforation usually occurs in advanced stage of the disease,
curative resection should be considered as far as possible.
Keywords: gastric cancer; gastrectomy; laparotomy; perforation; peritonitis.


1. Kasakura Y, Ajani JA, Fijii M, Mochizuki F, Takayama T.
Management of Perforated Gastric Carcinoma: A Report
of 16 Cases and Review of World Literature. Am Surg.
2. Kotan C, Sumer A, Baser M, Kızıltan R, Carparlar MA. An
Analysis of 13 Patients with Perforated Gastric Carcinoma:
A Surgeon's Nightmare? World J Emerg Surg. 2008;3:17-22.
3. Rovillo F, Rossi S, Marrelli D, De Manzoni G, Pedrazzani
C, Morgagni P et al. Perforated Gastric Carcinoma : Report
of 10 Cases and Review of Literature. World J Surg Oncol.
4. Jwo SC, Chıen RN, Chao TC, Chen YH, Lin CY.
Clinicopathological Features, Surgical Management, and
Disease Outcome of Perforated Gastric Cancer. J Surg Oncol.
5. Miura T, Ishii T, Shimoyama T, Hirano T, Tomita M.
Surgical Treatment of Perforated Gastric Cancer. Dig
6. Lehnert T, Buhl K, Dueck M, Hinz U, Herfarth C. Two-staged
Radical Gastrectomy for Perforated Gastric Cancer. Eur J
Surg Oncol. 2000;26:780-4.
7. Tsujimoto H, Hiraki S, Sakamoto N, Yaguchi Y, Horio T,
Kumano I et al. Outcome After Emergency Surgery in
Patients With a Free Perforation Caused by Gastric Cancer.
Expernt Therapt Med. 2010;1:199-203.
8. Ergul E, Gozetlik EO. Emergency Spontaneous Gastric
Perforations: Ulcer Versus Cancer. Langenbeck's Archiv
Surg. 2009;394:643-4.
9. Mukai M, Kondou Y, Ogoshi K, Noto T, makuuchi H, Tajima
T. A Case of Perforated Early Gastric Cancer and a Review
of 45 Cases Collected from Japanese Literature. J Jpn Soc Clin
10. Adachi Y, Mori M, Maehara Y, Mastsumata T, Okudaira
Y, Sugimachi K. Surgical Results of Perforated Gastric
Cancinoma: An Analysis of 155 Japanese Patients. Am J
11. Lee HJ, Park DJ, Yang HK, Lee KU, Choe KJ. Outcome after
Emergency Surgery in Gastric Cancer Patients with free
Perforation or Severe Bleeding. Dig Surg. 2006;23:217-23.
12. Wakato U, Hiroshi K, Hideki M, Hisashi N, Nobuhiko A
Yoichi N et al. A Study of Perforation of Gastric Cancer. J
Nihon Univ Med Asso. 2001;60:24-8.
How to Cite
Kandel, B. P., Singh, Y., Singh, K. P., & Khakurel, M. (2013). Gastric Cancer Perforation: Experience from a Tertiary Care Hospital. Journal of Nepal Medical Association, 52(191).
Original Article