The presence of a high CCA bifurcation should caution surgeons that the hypoglossal nerve lies in closer proximity and is more vulnerable. Preoperatively documenting the level of the CCA bifurcation may be helpful in identifying those patients at increased risk of iatrogenic injury.

Purpose  Some patients with gastric cancers develop acute complications and present acutely. It has been proposed that this group of patients have a worse prognosis. This paper describes the management of acute and elective gastric cancer patients at South Auckland Health. Methods  Patients were identified by electronic searching patient records from 2000 to 2006, and obtaining data pertaining to patient demographics, mode of presentation, management and outcome. Results  Two‐hundred and thirty eight patients were identified, of which 120 (50%) had an acute presentation. Patient demographics were similar in both groups, except for acute patients were older (77 years compared to 64 years; p < 0.001). Gastrointestinal bleeding and vomiting were more common in patients that presented acutely, 46% and 39% respectively, compared to 19% and 14% respectively in the elective group (p < 0.001). Fifty‐six percent of all patients underwent an operation; 36% had a curative resection, 11% palliative resection and 9% had an operation for the purpose of staging. Curative resection was undertaken more commonly in patients that presented electively (47%) than those that presented acutely (24%; p < 0.001). After curative resections, the median survival for acute patients was 30.3 months, with a 3 year overall survival rate of 41.6%, compared to 72% for elective patients (p < 0.0001). Conclusions  We have shown that 50% of patients with gastric cancer develop complications leading to an acute presentation. Only a minority of these patients are able to undergo resection with a curative intent, and consequently these patients have a poorer survival.