24 April 2023 | Medicover Hospitals
Case Presentation : A 47-year-old female with a known case of locally advanced Proximal gastric cancer underwent four cycles of neo-adjuvant chemotherapy now presented for definitive surgery.
Per-operative investigation were within normal limits. So patient was taken for staging laparoscopy with open total gastrectomy with D2 lymphadenectomy with esophago-jejunal anastomosis with jejune-jejunostomy and NJ placement. Surgery was uneventful, lasted for 4 hours with 250 ml blood loss. Patient was shifted to ICU for observation with epidural analgesia. Oral contrast study done on day 4 which suggests, good flow into jejunum without leakage at anastomotic site. Patient was started on liquids and later discharged on day 6. Pathologically it was T3N0M0 lesion, of 24 Lymph nodes removed, none was positive for tumor.
Total Gastrectomy Specimen
Post Operative X-ray with oral contrast
Discussion : Gastric Cancer is fourth common malignancy worldwide and remains the second cause of death of all malignancies worldwide. Gastric cancer results from a combination of environmental factors and accumulation of specific genetic alterations. The primary prevention includes healthy diet, anti-H. pylori therapies, chemoprevention, and screening for early detection. Dietary factors have an important impact on gastric carcinogenesis, especially in case of intestinal adenocarcinoma. Multidisciplinary approach for the planning of the GC treatment is mandatory. The multidisciplinary team (MDT) should include at least a surgeon, pathologist, gastroenterologist, medical and radiation oncologists.
Conclusion : Gastric Cancer is a malignant disease with a generally poor long-term prognosis. Most of the Gastric Cancers are sporadic subtypes that are strongly associated with environmental risk factors. Staging laparoscopy is a safe and effective staging modality in patients with gastric carcinoma. Surgery is the only potentially curative therapy for localized gastric cancer.