In the past 19-years period, we treated 24 cases with perforated gastric carcinoma, and operated 23 cases. The incidence was 1.5% of all the surgical cases of gastric cancer, and 24.0% of all the gastric perforation cases. Twenty patients underwent emergency surgeries. Correct preoperative diagnosis was made in 10 cases (50%), but 7cases already had been diagnosed as gastric cancer before perforation. There were 6 Stage III tumors and 7 IV tumors. Gastrectomy was performed in 18 cases which contained 11 cases of curative resections. Curability A, B). Twelve patients were treated palliatively (Curability C). The extent of lymph node dissection was D0 in 8, and D1 in 3. Two patients in curability A had long-term survivals, but 9 patients in B did not surrive. Mortality rate was 26.1% (6/23), and 5 cases were in Curability C. To establish the diagnosis as cancer after the perforation is not always easy. The poor risk patients should receive minimum treatments. If the preoperative diagnosis is correct, and the patient is in good condition, curative resection should be performed. But when the diagnosis is unclear, we leave the case in palliative surgery and a two-stage treatment is chosen as an option.