The diagnosis and surgical treatment of 8 patients with perforated gastric cancer were reviewed. The incidence of perforated gastric cancer was 1.2% among 675 gastric cancers and 22.9% among 35 gastric perforations. None of the cases was diagnosed as perforated gastric cancer on admission. Only 3 patients were suspected of having a malignancy intraoperatively. There were no clinical parameters that could distinguished the 8 perforated gastric cancer patients from the 27 perforated gastric ulcer patients. Urgent primary gastrectomy was performed to treat 4 perforated gastric cancer patients and 14 perforated gastric ulcer patients. The morbidity and mortality of urgent primary gastrectomy were 55.6% and 11.1%, respectively. To perform gastrectomy with standard lymph node dissection safely, we carried out secondary (elective) gastrectomy in 4 cases of perforated gastric cancer (after simple closure in 3 cases and conservative therapy in 1 case). Six patients with perforated gastric cancer have survived for over 2 years, and the median survival time of the 8 cases was 40 months. This suggested that a considerable number of patients with perforated gastric cancer can survive for a long period after radical gastrectomy. We recommend secondary radical gastrectomy within a week after simple closure as treatment for perforated gastric cancer.

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