Disease

recurrence was confirmed through radiological and/or pathological evaluation, while the overall survival duration was documented from the date of surgery until the date of death. All gastric cancers were staged according to the guidelines of the American Joint Committee of Cancer (AJCC) (7). The grades of complications (GOC) were in concordance to the classification proposed by Clavien and group (8)-(10) (Table 1). Table 1 Classification of surgical complications (8)-(10) Results During the study period, twelve patients (n = 8, 66.7% males) underwent surgery for perforated gastric cancer. Gastric adenocarcinoma and B -cell lymphoma were responsible for the perforation in nine (75.0%) and three (25.0%) patients respectively. Three had their Inhibitors,research,lifescience,medical gastric malignancy diagnosed prior. The median age of Inhibitors,research,lifescience,medical the study group was 75 (30~84) years, with the majority (n = 10, 83.3%) having an ASA score of 3 or 4. All patients presented with severe abdominal pain. Pneumoperitoneum on erect chest radiographs was seen in five (41.7%) patients while emergency confirmatory computed tomographic (CT) scans were performed in the rest. Majority (n = 9, 75.0%) of patients underwent surgery within 24 hours of presentation. Table Inhibitors,research,lifescience,medical 2 highlights the various characteristics of the study group. Table 2 Characteristics of the 12 patients who underwent surgery for perforated gastric malignancy Intra-operatively, seven (59.3%) patients

have severe peritoneal contamination. Ten (83.3%) had partial or subtotal gastrectomy performed with Bilroth II anastomosis, while the remaining two (16.7%) underwent total gastrectomy with a resulting Roux-en-Y anastomosis. Two patients died from septic complications Inhibitors,research,lifescience,medical contributed by pneumonia and intra-abdominal sepsis, one of whom had a duodenal stump leak which Gemcitabine chemical structure necessitated a subsequent laparotomy, drainage of the intra-abdominal collections and repair of duodenal stump dehiscence. The remaining ten patients were discharged well after a median length of stay of 16 Inhibitors,research,lifescience,medical (range: 8~100) days. Table 3 illustrates the surgical observations, procedure and outcome. Table 3 Surgical observations

and outcome of the study group Apart from the duodenal stump leak above, three other patients had duodenal stump leaks that were managed conservatively. Almost all the patients had either pulmonary or cardiovascular complications post-operatively. Adenocarcinoma Nine patients had adenocarcinoma. All had T3 disease and the only patient with N0 disease was one Rolziracetam of the fatalities, the rest of the patients all had involved lymph nodes. Three patients had metastatic disease diagnosed concurrently with peritoneal (n = 3) and liver (n = 1) involvement. Eight patients survived the initial operation. In the three patients with metastatic disease, one foreign patient defaulted follow up and went back to his home country. The other two passed away from their advanced disease at three and ten months post-operatively, respectively.