In the emergency group twenty-four patients (57.1%) presented with non-metastatic disease and the two year survival rate was 20.0% compared with 54.9% from elective group (189/249 patients). None of the emergency patients were alive after 40 months, while 36% of the elective

group were alive at this stage. The survival of patients with non-metastatic disease is shown in Figure 3. Figure 3 Comparison of survival for patients presenting with disease stage 1A-3B click here in the emergency and elective presentation groups. Survival following curative resections Of patients presenting as emergency who underwent subsequent resection 25% survived to 2 years. This compared to 67.4% two-year survival from elective group (p = <0.01). Five-year survival for elective patients undergoing operative intervention was 33.3% and there were no survivors in the emergency presentation FK228 in vivo group after 4 years (Figure 4). Figure 4 Comparison of survival for patients undergoing operative intervention in the emergency and elective presentation groups. Discussion Studies have shown that emergency presentation of gastric cancer is associated with higher stage disease and is an independent marker of poor prognosis. [3] Our results reinforce this as emergency patients more often presented with advanced stage disease; 45.0% of emergency patients presenting with stage IV, compared to 25.3% of elective patients (p <0.005), (Figure 1). Only 33.3% of emergency patients had resectable disease

(compared to 55.6% of elective patients) (p <0.01). There were no survivors to 4 years follow up in the emergency group whereas 33.3% of operable elective patients survived to 5 years. It is possible to claim that these results relate to the Anacetrapib more advanced stage disease in the emergency group and not the presenting modality. However, when survival data for patients with non-metastatic gastric malignancy (stages 1A-3B) is analysed this shows that despite comparable disease stage, patients who present as an emergency have a worse prognosis and decreased survival. This may be due to the physical insult and the acute physiological deterioration during emergency presentation. Similar results were found when survival was

compared for patients undergoing curative procedures. This suggests that emergency presentation could be an independent prognostic factor in gastric cancer. Other contributing factors to improved survival in the elective group may include the increased use of neo-adjuvant chemotherapy, and that patients presenting as an emergency may also be more severely malnourished at time of presentation. Our results showed that the need for operative intervention within 24 hours of presentation is rare with only 3 patients (<10% of the emergency presentation) during this six-year period requiring emergency surgery. Two of these cases were as a result of gastric perforation, and one was due to bleeding despite attempts to control this via endoscopic therapy.