7%) and 7 of these patients required blood transfusion. Elective patients presented with lower stage disease, stages 1 and 2 accounting for 37.6% of cases, compared with 23.1% of

the emergency cases (p < 0.05). Twenty-five percent of elective cases presented with stage 4 disease, compared to 45% of the emergency cases (p<0.005). Figure 1 Stage at presentation. Interventions and operative procedures STI571 purchase One hundred sixty-nine patients underwent operative intervention (58.1%), the remaining 122 patients had oncological, endoscopic or supportive palliative care. In the elective group 139 patients out of 249 (55.8%) were treated with curative intent, compared with 15 out of 42 (35.7%) in the emergency group (P < 0.05 with χ2 test). In the emergency

group 13 patients (30.9%) were unfit for any operative intervention and were treated palliatively, 14 patients (33.3%) underwent non-curative procedures (laparotomy with further procedure abandoned due to evidence of malignant spread (n = 3), gastro-jejunostomy (n = 6) or non-curative distal gastrectomy (n = 5)). Of emergency cohort patients 11 patients were suitable to undergo distal gastrectomy (26.2%) and total gastrectomy was performed in 4 cases (9.5%). In the elective group the pre-operative assessment, cross-sectional imaging and laparoscopy identified 106 patients, (42.5%) with unresectable or metastatic disease or patients were unfit to undergo major surgery. A further 9 patients (3.8%) were found to be unresectable at operation, one of these patients underwent local excision. GSI-IX mouse Three patients from the elective group who were suitable for resection declined the operative procedure. The surgical procedures performed are shown in Table 1. Table 1 Operations performed N = 291 Presentation Elective Acute     Number of patients Urease % Number of patients % Type of operation None 109 37.5 13 30.9 Total gastrectomy 61 20.9 4 9.5

Distal gastrectomy 69 23.7 16 38 Gastro-jejunostomy 1 0.3 6 14.3 Laparotomy/laparoscopy 8 2.7 3 7.1 Local excision 1 0.3 0 0   Total 249   42   Inpatient stay for patients undergoing operative intervention was similar for both groups. The median post-operative hospital stay for the emergency group was 9.5 days (IQR = 4), compared to 12 days (IQR = 7) in the elective group. Emergency surgery in the first 24 hours Three patients required emergency operation within 24 hours of admission. This represents 1% of all presentations, and 7.1% of emergency presentations of gastric carcinoma. In each of these cases the emergency procedure was performed by the On-call General Surgeon (Breast, Colorectal and Hepato-Biliary specialists). Two patients presented with gastric perforation and underwent emergency laparotomy. One patient was found to have metastatic disease and a palliative distal gastrectomy was performed. The second patient had a perforated gastric ulcer which was biopsied and an omental plug applied. The patient received palliative chemotherapy with no response.