Palliative Extended Multi organ Resection with Total Gastrectomy in A Patient with Gastric Outlet Obstruction. Is There Any Sense?

Special Article- Stomach cancer

Austin J Gastroenterol. 2014;1(5): 1022.

Palliative Extended Multi organ Resection with Total Gastrectomy in A Patient with Gastric Outlet Obstruction. Is There Any Sense?

De Tomás J*, Cuadrado M, Monturiol JM and Turégano F

Department of General Surgery, University General Hospital Gregorio Mara√Ī√≥n, Madrid, Spain

*Corresponding author: : De Tom√°s J, Department of General Surgery, University General Hospital Gregorio Mara√Ī√≥n, Calle Fuencarral 22 2¬ļ interior C 28004 Madrid, Spain

Received: September 23, 2014; Accepted: September 25, 2014; Published: September 27, 2014

Dear Editor:

Multiorgan resection associated with total gastrectomy has been accepted in cases of T4 gastric adenocarcinomas when a R0 resection could be completed [1-3]. These procedures are very complex and have high morbidity and mortality rates. Therefore, in cases of Gastric Outlet Obstruction (GOO) in gastric adenocarcinomas stage IV patients, endoscopic stents are perhaps a more appropriate therapeutic choice [4,5].

Intraluminal stents are extremely useful for bypassing tumors of the antropyloric region with GOO. However, in rare situations of scirrhous gastric adenocarcinomas with narrowing of long segments of the gastric lumen, those devices have a low rate of success.

We presented the case of a 65 year old male smoker who was treated with FOLFOX (folinic acid, fluorouracil and oxaliplatin) during a 2 month period due to a large T4 gastric tumor. After a lack of improvement with this therapeutic approach, a palliative procedure was considered to ameliorate vomiting in this patient. The post chemotherapy CT scan (Figure 1) disclosed a scirrhous type gastric cancer affecting the entire organ, pancreas, liver, and splenic hilum, with a partial splenic infarction. There was local lymph nodes enlargement without signs of peritoneal carcinomatosis. A barium swallow confirmed a long narrowing of the gastric lumen. Thus, gastric stenting was judged not to be useful in this particular case, and laparotomy was offered to the patient. After preoperative total parenteral nutrition for 14 days, the serum albumin level was 3.2 g/ dL.

Citation: De Tomás J, Cuadrado M, Monturiol JM and Turégano F . Palliative Extended Multi organ Resection with Total Gastrectomy in A Patient with Gastric Outlet Obstruction. Is There Any Sense?. Austin J Gastroenterol. 2014;1(5): 1022. ISSN:2381-9219