List Archives

Thu Jan 27 14:41:23 GMT 2005

just one more that i should have sent with the last post

1: Am Surg. 2002 May;68(5):434-40. Management of perforated gastric carcinoma: a report of 16 cases and review of world literature. Kasakura Y, Ajani JA, Fujii M, Mochizuki F, Takayama T. Department of Gastrointestinal Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, USA. Perforated gastric carcinoma is rare; however, it is a serious condition associated with complications. To understand the proper management of this disease and to characterize its clinical course we reviewed available data on 16 patients with perforated gastric carcinoma. We collected data on the age and sex of the patients as well as operative findings and histological features of the primary tumor. The depth of invasion and presence of lymph node metastasis were also recorded. The Union Internationale Contre Cancer stage, extent of resection, and surgical method used were reviewed. We also reviewed published information on the management of perforated gastric carcinoma. The carcinoma was stage I in three cases, stage II in one case, stage III in three cases, and stage IV in nine cases. Many patients had distant metastases. Fourteen patients underwent gastrectomy. Two patients whose preoperative condition was poor died of surgery-related complications, but patients with early-stage carcinoma underwent an R0 resection (resection of the primary tumor with negative margins) and had minimal complications. We conclude that the outcome of patients who were able to undergo radical surgery was good and correlated with the stage of cancer. It is important to perform gastrectomy rather than repair the perforation first, and a proper lymphadenectomy should follow--thus a two-step surgery when necessary. 

> ----------
> From: 	KMATTOX at aol.com[SMTP:KMATTOX at aol.com]
> Reply To: 	Trauma & Critical Care mailing list
> Sent: 	quinta-feira, 27 de janeiro de 2005 10:56
> To: 	trauma-l at lists.aast.org; trauma-list at trauma.org; ccm-l at ccm-l.org
> Subject: 	Time for decision & action
> 
> The frozen section came back, poorly differentiated adenocarcinoma of the 
> stomach.   a 10 cm proximal margin would be in the distal esophagus.   a 12 cm 
> distal margin would be beyond the incisura angularis and leave distal gastric 
> pouch of about 12 cm.   If I resect, should it be a wedge or proximal 
> gastrectomy?   Should I take the spleen?  Should I take the greater omentum?    Can this 
> man be reconstructed?   How do I temporize?   Should I close and send him to 
> a cancer hospital.  Should I call a GI surgeon or a cancer surgeon to come 
> help me.    The resident across the table from me has done zero gastrectomies 
> during her residency.     AND her 80 hour work week is over in 3 hours.     
> 
> HELP.  
> 
> The best time to do something for this patient is now while the belly is 
> open. 
> 
> k
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