Unresectable gastric tumor in dog - Forum

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Vet

Unresectable gastric tumor in dog - Ärzteforum

Post#1 »

A query on how you all might surgically (or non-surgically) manage a patient with a sarcoma (probable leiomyosarcoma---smooth muscle tissue stains are pending) involving the stomach and pylorus from the incisura angularis to the proximal duodenum (2 cm proximal to the duodenal papilla). Regional lymph nodes are positive and metastatic lesions are present in the mesentery surrounding the celiac artery. There is no obstruction to biliary flow although the pylorus is nearly completely obstructed (determined endoscopically) causing the patient to vomit after eating. This patient is a 10 year old female dog. Options include a re-routing procedure Roux-en-Y vs. jejunostomy feeding tube only.


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Surgeon

Re: Unresectable gastric tumor in dog - Ärzteforum

Post#2 »

I did not know that gastric leomyosarcoma speards to the lymphnodes-perhaps in the dog it does.

Gastrojejunostomy.

Grandpa Phil

Re: Unresectable gastric tumor in dog - Ärzteforum

Post#3 »

Would not consider feeding jejunostomy alone.Not palliative. If low grade lesion, would resect and gastrojejunostomy.If high grade, no resection and gaststrojejunostomy.

Gemcitabine

Re: Unresectable gastric tumor in dog - Ärzteforum

Post#4 »

I also would recommend gastrojejunostomy if possible, but was concerned that this tumor might involve too much of stomach to make this possible. Jejunostomy is unlikely to be very helpful. In humans, it has been shown that feeding gastrostomy as the only attempted palliation for esophageal cancer is not helpful and not recommended. I would assume a simple feeding jejunostomy would similarly not truly palliate the animal.

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Oncologist

Re: Unresectable gastric tumor in dog - Ärzteforum

Post#5 »

As the tumour involves distal rather than proximal stomach, you may consider Devine's "exclusion operation", devised for symptomatic relief of irremovable gastric cancer. The stomach is mobilised if appropriate to the particular case. It is then transected, and the distal segment is oversewn. The proximal segment is also closed, except for a gastrojejunostomy. Of course as in humans the kindest option may be palliative care without surgery.

Grandpa Phil

Re: Unresectable gastric tumor in dog - Ärzteforum

Post#6 »

I vote gastrojejunostomy.

Cisplatin

Re: Unresectable gastric tumor in dog - Ärzteforum

Post#7 »

Non-resectable abdominal carcinomas in humans have notoriously poor results with bypass. They will often continue having obstructive symptoms despite a technically successful bypass. I would have to assume this holds true with sarcomas as well, although I have no experience with the actual entity you describe. I prefer a gastrostomy tube for terminal disease. This allows you to vent the stomach and keep them from vomiting. At least they remain comfortable from that standpoint and don't need a (miserable) NG tube. As for the jejunostomy, I feel pretty fatalistic about tube feedings in terminal patients.

Gaster

Re: Unresectable gastric tumor in dog - Ärzteforum

Post#8 »

10 x 7= 70 and so we are talking about a 70 year old patient here in terms of human years, what quality of life she might have after your procedure? with regional node involvement, how long do you think she might have to live, I think your job is to just improve her quality of life, whatever remains of it, are you prolonging her life or are you prolonging her agony?

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