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Review
. 2025 Jun 29;14(13):4603.
doi: 10.3390/jcm14134603.

One-Stage Versus Two-Stage Gastrectomy for Perforated Gastric Cancer: Systematic Review and Meta-Analysis

Michele Manara  1 , Alberto Aiolfi  1 , Quan Wang  2 , Gianluca Bonitta  1 , Galyna Shabat  2 , Antonio Biondi  3 , Matteo Calì  1 , Davide Bona  1 , Luigi Bonavina  2
Affiliations
Review

One-Stage Versus Two-Stage Gastrectomy for Perforated Gastric Cancer: Systematic Review and Meta-Analysis

Michele Manara et al. J Clin Med. .

Abstract

Background/Objectives: The optimal surgical management of perforated gastric cancer (PGC) in emergency settings remains controversial. Urgent upfront one-stage gastrectomy (1SG) and two-stage gastrectomy (2SG) with damage-control surgery followed by elective gastrectomy have been proposed. The aim of the present systematic review is to compare short- and long-term outcomes between 1SG and 2SG in the treatment of PGC. Methods: A systematic review and individual patient data (IPD) meta-analysis of studies reporting data of patients undergoing 1SG vs. 2SG for PGC was conducted. The time-dependent effects of surgical interventions were assessed using a likelihood ratio test. Hazard function plots were generated via marginal prediction. Results: Ten retrospective series (579 patients) were included. Overall, 482 patients (83%) underwent 1SG, while 97 patients (17%) were treated with 2SG. A trend toward better short-term oncological outcomes and safety profiles for 2SG compared to 1SG was observed. Long-term outcomes were comparable between 1SG and 2SG, and the IPD meta-analysis showed no statistically significant difference between the two approaches in terms of OS or hazard for mortality at all time points. A trend towards a higher hazard for mortality was observed for 1SG in the first 20 months postoperatively. Conclusions: Our analysis suggests that 1SG and 2SG yield comparable short-term outcomes, although 2SG may be associated with a lower medium-term mortality risk. Further research is needed to identify key factors to improve clinical judgments and decision-making in PGC.

Keywords: damage control surgery; gastrectomy; gastric cancer; gastric perforation.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
The Preferred Reporting Items for Systematic Review checklist diagram.
Figure 2
Figure 2
Time-varying hazard for mortality following one-stage (black line) and two-stage (red line) gastrectomy. Solid lines represent the mean estimated hazard over time, while dashed lines indicate the standard deviation for each surgical approach.
Figure 3
Figure 3
Hazard ratio for mortality between one-stage and two-stage gastrectomy. Solid line represent the mean hazard ratio over time, while dashed lines indicate the standard deviation.
Figure 4
Figure 4
Overall survival for one-stage (black line) and two-stage (red line) gastrectomy. Solid lines represent the mean overall survival over time, while dashed lines indicate the standard deviation for each surgical approach.
See this image and copyright information in PMC

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