Gastric cancer: choice of operation and antibiotics - Forum

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Resident

Re: Gastric cancer: choice of operation and antibiotics - Ärzteforum

Post#11 »

Recently, with a similar situation, a 88 yo female also diagnosed
gastric ca. with a "bleeding" complication was scheduled for presumably "palliative" gastrectomy. Intraoperative finding showed a good size lesion (grossly 4-5 cm) on the anterior wall, too close to
GE junction to get a 6 cm margin. (+) peritoneal seeding.What do you do, assuming she is an OK surgical candidate 88 yo?
? It's wrong to operate, to begin with?
? Total gastrectomy? One, including my attd, feared M&M
? Big wedge excision, which we did, and left behind
a very ugly,and funny bottle-shaped deformity stomach remnant.


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Oncologist

Re: Gastric cancer: choice of operation and antibiotics - Ärzteforum

Post#12 »

Marcel wrote:About the operation in this case let me be a devil's advocate.
Ofcourse total gastrectomy with a distal pancreatectomy are a "fun"
procedure and a "piece of cake" for us big surgeons. But it is associated
with a well documented high M &M. Is the latter justified? Does it
translates to a better survival rate and better quality of life? This
lady was not really "bleeding", David- a little iron over 6 months is not
a "great deal" . You know that gastric ca patients very rarely
exanguinate. You mentioned "palliation" but what are you really palliating
here?

You are experts in ca stomach- are you convinced that
radical surgery will really prolong this patient's life and it's quality-
ofcourse if she survives with God's helps- and without antibiotics- the
"second hit".

A. have done a perfect job for this lady, he gave her a chance of 25%
five years survival, compared to 0% five years survival if a lesser operation
or palliative procedure was performed. Any M&M will be acceptable in the
background of 0% five years survival. If complete resection (R0) is achieved,
extended resection for locally advanced gastric carcinoma provides survival
time, which is comparable, stage for stage, with survival rates observed after
R0 resection for cancer limited to the stomach.

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Surgeon

Re: Gastric cancer: choice of operation and antibiotics - Ärzteforum

Post#13 »

Resident wrote:Recently, with a similar situation, a 88 yo female also diagnosed
gastric ca. with a "bleeding" complication was scheduled for presumably "palliative" gastrectomy. Intraoperative finding showed a good size lesion (grossly 4-5 cm) on the anterior wall, too close to
GE junction to get a 6 cm margin. (+) peritoneal seeding.What do you do, assuming she is an OK surgical candidate 88 yo?
? It's wrong to operate, to begin with?
? Total gastrectomy? One, including my attd, feared M&M
? Big wedge excision, which we did, and left behind
a very ugly,and funny bottle-shaped deformity stomach remnant.


Peritoneal dissemination in cancer stomach is a contraindication for any surgical intervention, you can diagnose it preoperatively by a rectal examination, or by laparoscopic inspection before
laparotomy. The worst thing to do in cancer stomach is to cut through malignant tissue, or to leave malignant tissue behind, local recurrence is very quick and is a terribly devastating event.
Unfortunately you have done the worst option to your patient.

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