{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T04:58:41Z","timestamp":1785473921678,"version":"3.56.0"},"reference-count":36,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Health & Welfare, Republic of Korea","award":["RS-2026-25517509"],"award-info":[{"award-number":["RS-2026-25517509"]}]},{"award":["RS-2026-25517509"],"award-info":[{"award-number":["RS-2026-25517509"]}],"id":[{"id":"https:\/\/ror.org\/00vxgjw72","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002642","name":"Korea University","doi-asserted-by":"crossref","award":["K2605861"],"award-info":[{"award-number":["K2605861"]}],"id":[{"id":"10.13039\/501100002642","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002642","name":"Korea University","doi-asserted-by":"crossref","award":["K2613701"],"award-info":[{"award-number":["K2613701"]}],"id":[{"id":"10.13039\/501100002642","id-type":"DOI","asserted-by":"crossref"}]},{"award":["K2605861"],"award-info":[{"award-number":["K2605861"]}],"id":[{"id":"https:\/\/ror.org\/05m1gnk07","id-type":"ROR","asserted-by":"publisher"}]},{"award":["K2613701"],"award-info":[{"award-number":["K2613701"]}],"id":[{"id":"https:\/\/ror.org\/05m1gnk07","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Gastric cancer complicated by free perforation is a rare but life-threatening oncological emergency, accounting for 0.3% ~ 3.9% of all gastric cancer cases. This review summarizes current evidence on the epidemiology, diagnosis, surgical management, and prognostic determinants of perforated gastric cancer, with emphasis on stage-adapted treatment strategies. It should be noted, however, that the available evidence is derived exclusively from retrospective studies, and all recommendations should be interpreted in the context of this inherent limitation. Relevant studies addressing perforation patterns, perioperative outcomes, one-stage versus two-stage gastrectomy, repair-only approaches, and management of metastatic disease were reviewed. Perforation typically arises from tumors located on the anterior wall or greater curvature, where transmural invasion creates direct communication with the peritoneal cavity, resulting in diffuse peritonitis and substantial postoperative mortality. Available pooled evidence suggests that radical resection, when oncologically and physiologically feasible, is associated with better survival than repair-only strategies. Comparative retrospective data suggest that two-stage gastrectomy may be associated with higher R0 resection rates and lower in-hospital mortality compared with emergency one-stage resection, without compromising long-term survival when curative resection is ultimately achieved; however, these findings should be interpreted with caution given the exclusively retrospective evidence base and the inherent patient selection bias in all published comparisons. In patients with stage IV disease or confirmed distant metastases, stomach-preserving source control followed by systemic chemotherapy may be a rational alternative. Prognosis is primarily determined by TNM stage and R0 resection status, similar to non-perforated gastric cancer. Individualized treatment based on tumor stage, resectability, peritoneal contamination, and physiological reserve is essential.<\/jats:p>","DOI":"10.3390\/jcm15155931","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T13:53:31Z","timestamp":1785333211000},"page":"5931","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perforated Gastric Cancer: Epidemiology, Diagnosis, and Surgical Management Strategies"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9061-6236","authenticated-orcid":false,"given":"Sang-Ho","family":"Jeong","sequence":"first","affiliation":[{"name":"Department of Surgery, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon 51472, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung Jin","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan 48108, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5771-3832","authenticated-orcid":false,"given":"Kyung Won","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Kosin University Gospel Hospital, Busan 49267, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5798-4595","authenticated-orcid":false,"given":"Jae-Seok","family":"Min","sequence":"additional","affiliation":[{"name":"Division of Foregut Surgery, Department of Surgery, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"ref_1","first-page":"516","article-title":"Surgical results of perforated gastric carcinoma: An analysis of 155 Japanese patients","volume":"92","author":"Adachi","year":"1997","journal-title":"Am. 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