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
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
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.
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