This document provides information about gastric cancer including diagnosis, staging, treatment and reconstruction after surgery. Key points include:
- Diagnosis involves endoscopy with biopsy and radiologic tests to determine staging. Early gastric cancer is confined to the mucosa or submucosa.
- Risk factors include H. pylori infection and family history. Surgery is the only curative treatment and involves lymph node dissection and resection with margins of at least 3-5 cm.
- Resection may be distal gastrectomy or total gastrectomy depending on location of tumor. Reconstruction options after resection include Billroth I, Billroth II, or Roux-en-Y procedures.
The document discusses esophageal cancer and adenocarcinoma of the esophagogastric junction. It provides details on:
1) The anatomy of the esophagus and locations of narrowing points.
2) Risk factors, clinical manifestations, staging, and diagnostic evaluations for esophageal cancer.
3) Treatment options including surgery, chemotherapy, radiation therapy, and palliative care.
4) Principles of endoscopic staging, therapy and surgery are outlined.
The document discusses hilar cholangiocarcinoma (CCA), a rare and deadly form of cancer. It defines hilar CCA and describes its risk factors, clinical presentation, diagnostic evaluation including imaging and tumor markers, and treatment approaches. For treatment, it discusses staging systems, criteria for resectability, preoperative evaluation and biliary drainage, surgical resection techniques including lymphadenectomy, the role of adjuvant chemotherapy, and palliative options. Complete surgical resection with negative margins offers the only chance for cure, but postoperative outcomes remain poor due to the advanced stage at diagnosis and high rate of recurrence.
This document discusses the pathogenesis, diagnosis, and treatment of morbid obesity. It covers the chronic disease management model for primary care of patients with overweight and obesity. Key aspects include calculating BMI, assessing weight-related risks, setting weight loss and lifestyle goals, and referring patients for bariatric surgery if appropriate. The document also describes various bariatric surgery procedures like gastric banding, gastric bypass, sleeve gastrectomy, and duodenal switch. It provides details on patient selection, pre- and post-operative care, outcomes, and complications of these procedures.
Esophageal motility disorders involve abnormalities in the muscular contractions that propel food through the esophagus. The document discusses several primary motility disorders including achalasia, diffuse esophageal spasm, nutcracker esophagus, and ineffective motility disorder. It also covers secondary motility disorders caused by connective tissue diseases. Diagnosis involves tests to detect structural abnormalities, functional abnormalities, increased gastric acid exposure, and duodenogastric function. Treatment depends on the specific disorder but may include medications, botulinum toxin injections, pneumatic dilation, surgery such as myotomy, and treatments for any underlying causes.
This document provides an overview of colorectal trauma and injuries. It discusses relevant anatomy, considerations for colonic and rectal trauma including classification systems, management approaches, and risks factors. It also reviews iatrogenic injuries that can occur from various surgical, endoscopic, and diagnostic procedures. Key points include that nondestructive colon injuries can often be primarily repaired, while destructive injuries require resection. Rectal injuries are classified using the "4Ds" concept of debridement, drainage, washout, and sometimes diversion.
Management of HCC: what we can do from staging systemHappyFridayKnight
The document provides an overview of hepatocellular carcinoma (HCC) including etiology, risk factors, prevention, surveillance, diagnosis, staging, and treatment strategies. It discusses various HCC staging systems including Child-Turcotte-Pugh, Okuda, CLIP, BCLC, and TNM. The BCLC system is highlighted as it considers tumor burden as well as liver functional status in determining prognosis and optimal treatment. Treatment options are discussed including resection, transplantation, ablation, transarterial chemoembolization, and sorafenib depending on patient and tumor characteristics. Accurate staging is important for determining prognosis and selecting the most appropriate treatment approach.
The document discusses esophageal cancer and adenocarcinoma of the esophagogastric junction. It provides details on:
1) The anatomy of the esophagus and locations of narrowing points.
2) Risk factors, clinical manifestations, staging, and diagnostic evaluations for esophageal cancer.
3) Treatment options including surgery, chemotherapy, radiation therapy, and palliative care.
4) Principles of endoscopic staging, therapy and surgery are outlined.
The document discusses hilar cholangiocarcinoma (CCA), a rare and deadly form of cancer. It defines hilar CCA and describes its risk factors, clinical presentation, diagnostic evaluation including imaging and tumor markers, and treatment approaches. For treatment, it discusses staging systems, criteria for resectability, preoperative evaluation and biliary drainage, surgical resection techniques including lymphadenectomy, the role of adjuvant chemotherapy, and palliative options. Complete surgical resection with negative margins offers the only chance for cure, but postoperative outcomes remain poor due to the advanced stage at diagnosis and high rate of recurrence.
This document discusses the pathogenesis, diagnosis, and treatment of morbid obesity. It covers the chronic disease management model for primary care of patients with overweight and obesity. Key aspects include calculating BMI, assessing weight-related risks, setting weight loss and lifestyle goals, and referring patients for bariatric surgery if appropriate. The document also describes various bariatric surgery procedures like gastric banding, gastric bypass, sleeve gastrectomy, and duodenal switch. It provides details on patient selection, pre- and post-operative care, outcomes, and complications of these procedures.
Esophageal motility disorders involve abnormalities in the muscular contractions that propel food through the esophagus. The document discusses several primary motility disorders including achalasia, diffuse esophageal spasm, nutcracker esophagus, and ineffective motility disorder. It also covers secondary motility disorders caused by connective tissue diseases. Diagnosis involves tests to detect structural abnormalities, functional abnormalities, increased gastric acid exposure, and duodenogastric function. Treatment depends on the specific disorder but may include medications, botulinum toxin injections, pneumatic dilation, surgery such as myotomy, and treatments for any underlying causes.
This document provides an overview of colorectal trauma and injuries. It discusses relevant anatomy, considerations for colonic and rectal trauma including classification systems, management approaches, and risks factors. It also reviews iatrogenic injuries that can occur from various surgical, endoscopic, and diagnostic procedures. Key points include that nondestructive colon injuries can often be primarily repaired, while destructive injuries require resection. Rectal injuries are classified using the "4Ds" concept of debridement, drainage, washout, and sometimes diversion.
Management of HCC: what we can do from staging systemHappyFridayKnight
The document provides an overview of hepatocellular carcinoma (HCC) including etiology, risk factors, prevention, surveillance, diagnosis, staging, and treatment strategies. It discusses various HCC staging systems including Child-Turcotte-Pugh, Okuda, CLIP, BCLC, and TNM. The BCLC system is highlighted as it considers tumor burden as well as liver functional status in determining prognosis and optimal treatment. Treatment options are discussed including resection, transplantation, ablation, transarterial chemoembolization, and sorafenib depending on patient and tumor characteristics. Accurate staging is important for determining prognosis and selecting the most appropriate treatment approach.
This document discusses various causes of large bowel obstruction including cancer, inflammation, volvulus, and Ogilvie's syndrome. It provides details on the diagnostic evaluation, imaging findings, and treatment options for partial versus complete, simple versus strangulating obstructions. The most common mechanical cause is colorectal cancer while the most common adynamic cause is acute colonic pseudo-obstruction. Treatment depends on the etiology and includes resection, stenting, decompression, and creation of a stoma.
The document outlines an Enhanced Recovery After Surgery (ERAS) protocol to improve perioperative patient care. It discusses preoperative, intraoperative, and postoperative interventions including prehabilitation, minimizing fasting times, multimodal analgesia, early mobilization and nutrition to reduce stress, complications and length of stay. Key elements are preoperative counseling and optimization, short-acting anesthesia, fluid balance, prevention of hypothermia, early removal of tubes/drains and promotion of gut motility. Special considerations for different surgeries like colorectal, rectal and liver procedures are also covered. The conclusion emphasizes communication, preparing patients physically and mentally for surgery and auditing outcomes.
This document discusses various diseases of the colon, rectum, anus and provides treatment options. It covers:
1. Left sided colonic obstruction from colorectal cancer and options like stenting, colostomy, resection.
2. Colorectal liver metastases and various treatment sequences involving chemotherapy and surgery.
3. Left sided diverticulitis classified by Hinchey stages and treatments like resection or Hartmann's procedure.
4. Benign anorectal diseases including infections, hemorrhoids and rectal prolapse. Treatment may involve drainage, fistulotomy or abdominal procedures.
Malignant bowel obstruction is caused by luminal narrowing of the small or large bowel due to metastatic intra-abdominal cancer. The most common primary cancers are colorectal, ovarian, breast, and melanoma. Treatment aims to palliatively relieve symptoms like pain, nausea, and vomiting to improve quality of life, as cure is not possible. Both non-operative treatments like octreotide, opioids, antiemetics, and stenting as well as surgical options may be considered depending on the extent of malignancy and patient's condition. The goal is symptom control and allowing oral intake and return home if possible.
This document provides an overview of common gastric problems for interns, including approaches to epigastric pain, alarm features in dyspeptic patients, and gastrointestinal evaluation of iron deficiency anemia. It discusses peptic ulcer disease, including causes, complications like bleeding and perforation, and treatment options. Evaluation of epigastric pain involves ruling out life-threatening conditions before considering treatments for conditions like gastritis. Endoscopy is recommended for dyspeptic patients with alarm features or risk factors for malignancy.
Oncology: basic science for general surgical residentsHappyFridayKnight
The document discusses oncology and cancer biology. It defines neoplasia as uncontrolled proliferation of transformed cells. The primary goals of surgical and radiation therapy for cancer are local and regional control, while systemic therapy aims for systemic control to prevent distant recurrence. The most common cancers worldwide are lung cancer in men and breast cancer in women. Cancer diagnosis involves methods like biopsy to obtain a definitive diagnosis. Staging systems like TNM are used to determine cancer progression. A multidisciplinary approach utilizing surgery, radiation, chemotherapy, targeted therapy and other modalities can improve survival rates compared to surgery alone.
This document provides an overview of pancreatic surgery and management of pancreatic conditions. It discusses the anatomy of the pancreas, classification and management of acute pancreatitis including necrotizing pancreatitis. It covers the indications, timing and approaches for intervention in infected pancreatic necrosis, including radiologic drainage, minimally invasive techniques like VARD and nephroscopic debridement, and open necrosectomy. It also summarizes the principles and techniques of surgical management of pancreatic cancer.
Role and types of surgery in chronic pancreatitisShambhavi Sharma
This document discusses the role and types of surgery in chronic pancreatitis. It begins with an introduction and overview of chronic pancreatitis and its causes. It then discusses the various symptoms and complications that can arise. The document outlines the surgical and non-surgical management options, including drainage procedures like Puestow's procedure and resection procedures like pancreaticoduodenectomy. It provides details on the indications, advantages, and disadvantages of different surgical procedures. The key message is that surgery aims to relieve pain and complications while preserving pancreatic function as much as possible.
This document discusses the surgical management of acute pancreatitis. There are several indications for surgical intervention including diagnostic uncertainty, non-pancreatic causes like perforated viscus, infected necrosis, severe sterile necrosis, and symptomatic organized pancreatic necrosis. Infected pancreatic necrosis requires surgical debridement to treat as mortality is 100% if left untreated. Severe sterile pancreatic necrosis may also require surgery if the patient deteriorates or develops infection. Surgical procedures discussed include cholecystectomy, ERCP, CBD exploration, pancreaticojejunostomy, pancreatic resection, pancreatic debridement, and drainage of pancreatic abscesses.
A brief in esophageal caustic injury for surgical residentsHappyFridayKnight
This document provides information on esophageal caustic injury for surgical residents. It discusses the clinical manifestations of corrosive ingestion including hoarseness, dysphagia, and pain. Complications include short-term risks like perforation and long-term risks like stricture formation. It describes the pathophysiology of injury depending on substance pH and outlines investigations including endoscopy to assess injury severity. Management involves initial stabilization, monitoring based on injury grade from endoscopy, and later treatment of strictures with dilation or surgery if dilation fails.
Oesophageal cancer is a disease that affects the esophagus. The document provides details about:
1) The anatomy, histology, blood supply, lymphatic drainage and functions of the esophagus.
2) Risk factors, symptoms, epidemiology, macroscopic and microscopic appearance of oesophageal cancer.
3) Diagnostic tests and staging of oesophageal cancer including endoscopy, imaging, and biopsy.
4) Treatment options for oesophageal cancer including surgery, chemotherapy, radiation therapy and palliative care based on the cancer stage. Prognostic factors and performance status scales are also discussed.
The document discusses surgical management of chronic pancreatitis. It describes various surgical procedures for treating chronic pancreatitis including resection procedures like Whipple procedure, drainage procedures like Puestow's procedure, and hybrid procedures like Frey procedure. Studies have shown that duodenum-preserving pancreatic head resection procedures and longitudinal pancreaticojejunostomy provide better postoperative outcomes and pain control compared to resection procedures while preserving exocrine and endocrine function. The document concludes that surgery is effective for relieving pain in chronic pancreatitis and duodenum-preserving pancreatic head resection procedures have advantages over other surgical options.
Pancreatico-pleural fistula occurs when pancreatic secretions drain directly into the pleural cavity, often as a complication of pancreatitis or pancreatic trauma. Patients typically present with pulmonary symptoms like cough and dyspnea rather than abdominal pain. Diagnosis involves detecting high amylase levels in pleural fluid. Treatment begins conservatively with thoracentesis and octreotide to reduce secretions, but refractory cases may require ERCP with stenting or pancreatic surgery to relieve duct obstructions causing the fistula. While difficult to treat, identifying the condition helps avoid delayed diagnosis and directs management toward minimizing pancreatic stimulation and draining associated fluid collections.
The document summarizes the surgical management of chronic pancreatitis. It describes various procedures including drainage procedures like Puestow and Partington & Rochelle procedures, and resective procedures such as duodenum-preserving pancreatic head resection (DPPHR), Frey procedure, and Whipple procedure. It compares these procedures in terms of indications, advantages, disadvantages, postoperative outcomes based on randomized controlled trials. The optimal treatment depends on the severity and location of disease.
Benign tumors of the esophagus include leiomyomas, cysts, and polyps. Leiomyomas are the most common benign tumor, usually occurring in the lower two-thirds of the esophagus in males. Esophageal cysts often present in childhood and are located along the right side. Malignant esophageal tumors are usually advanced at diagnosis and involve the muscular wall. Squamous cell carcinoma is most common and risk factors include smoking and alcohol. Diagnosis involves endoscopy with biopsy and imaging such as CT scan. Treatment options include surgery, chemotherapy, and radiation, but long-term survival remains low given late-stage presentation.
This document discusses chronic pancreatitis, including its definition, causes, symptoms, diagnostic tests, and surgical treatment options. It notes that chronic pancreatitis is characterized by irreversible morphological changes and permanent loss of pancreatic function. The main indications for surgery are intractable pain and complications. Surgical options include drainage procedures like longitudinal pancreaticojejunostomy or cyst-enterostomies, as well as resections like Whipple procedure or distal pancreatectomy. The goals of surgery are pain relief, control of complications, and improved quality of life. While surgery provides sustained pain relief in over 85% of patients, outcomes may be complicated by associated issues like portal hypertension.
Surgical management of chronic pancreatitis.PritamMandal18
Chronic pancreatitis is characterized by irreversible damage to the pancreas from chronic inflammation and scarring that results in loss of exocrine and endocrine function. Risk factors include alcohol use, genetics, and recurrent acute pancreatitis. Diagnosis involves history, labs, imaging, and function tests. Management is initially conservative but may include endoscopic or surgical interventions for pain relief, complications, or disease progression. Surgical options include drainage procedures or resections, with randomized trials showing various techniques have comparable outcomes.
Post ERCP tension pneumo-thorax a rare complication Ibrahim Masoodi
A 65-year-old female presented with right upper quadrant pain and vomiting for 5 days. Imaging showed CBD stones. During a difficult ERCP involving pre-cut sphincterotomy, the patient developed tension pneumothorax. Exploration found a duodenal tear that was repaired. Tension pneumothorax is a rare but serious complication of ERCP due to retroperitoneal or intraperitoneal air dissection through diaphragmatic pores. Immediate diagnosis and treatment is needed to prevent hemodynamic compromise.
reviewed the literature ;Multidisciplinary management of gastric cancer
Yixing Jianga and Jaffer A. Ajani
; pictures taken from Sabiston textbook of surgery.
This document discusses various causes of large bowel obstruction including cancer, inflammation, volvulus, and Ogilvie's syndrome. It provides details on the diagnostic evaluation, imaging findings, and treatment options for partial versus complete, simple versus strangulating obstructions. The most common mechanical cause is colorectal cancer while the most common adynamic cause is acute colonic pseudo-obstruction. Treatment depends on the etiology and includes resection, stenting, decompression, and creation of a stoma.
The document outlines an Enhanced Recovery After Surgery (ERAS) protocol to improve perioperative patient care. It discusses preoperative, intraoperative, and postoperative interventions including prehabilitation, minimizing fasting times, multimodal analgesia, early mobilization and nutrition to reduce stress, complications and length of stay. Key elements are preoperative counseling and optimization, short-acting anesthesia, fluid balance, prevention of hypothermia, early removal of tubes/drains and promotion of gut motility. Special considerations for different surgeries like colorectal, rectal and liver procedures are also covered. The conclusion emphasizes communication, preparing patients physically and mentally for surgery and auditing outcomes.
This document discusses various diseases of the colon, rectum, anus and provides treatment options. It covers:
1. Left sided colonic obstruction from colorectal cancer and options like stenting, colostomy, resection.
2. Colorectal liver metastases and various treatment sequences involving chemotherapy and surgery.
3. Left sided diverticulitis classified by Hinchey stages and treatments like resection or Hartmann's procedure.
4. Benign anorectal diseases including infections, hemorrhoids and rectal prolapse. Treatment may involve drainage, fistulotomy or abdominal procedures.
Malignant bowel obstruction is caused by luminal narrowing of the small or large bowel due to metastatic intra-abdominal cancer. The most common primary cancers are colorectal, ovarian, breast, and melanoma. Treatment aims to palliatively relieve symptoms like pain, nausea, and vomiting to improve quality of life, as cure is not possible. Both non-operative treatments like octreotide, opioids, antiemetics, and stenting as well as surgical options may be considered depending on the extent of malignancy and patient's condition. The goal is symptom control and allowing oral intake and return home if possible.
This document provides an overview of common gastric problems for interns, including approaches to epigastric pain, alarm features in dyspeptic patients, and gastrointestinal evaluation of iron deficiency anemia. It discusses peptic ulcer disease, including causes, complications like bleeding and perforation, and treatment options. Evaluation of epigastric pain involves ruling out life-threatening conditions before considering treatments for conditions like gastritis. Endoscopy is recommended for dyspeptic patients with alarm features or risk factors for malignancy.
Oncology: basic science for general surgical residentsHappyFridayKnight
The document discusses oncology and cancer biology. It defines neoplasia as uncontrolled proliferation of transformed cells. The primary goals of surgical and radiation therapy for cancer are local and regional control, while systemic therapy aims for systemic control to prevent distant recurrence. The most common cancers worldwide are lung cancer in men and breast cancer in women. Cancer diagnosis involves methods like biopsy to obtain a definitive diagnosis. Staging systems like TNM are used to determine cancer progression. A multidisciplinary approach utilizing surgery, radiation, chemotherapy, targeted therapy and other modalities can improve survival rates compared to surgery alone.
This document provides an overview of pancreatic surgery and management of pancreatic conditions. It discusses the anatomy of the pancreas, classification and management of acute pancreatitis including necrotizing pancreatitis. It covers the indications, timing and approaches for intervention in infected pancreatic necrosis, including radiologic drainage, minimally invasive techniques like VARD and nephroscopic debridement, and open necrosectomy. It also summarizes the principles and techniques of surgical management of pancreatic cancer.
Role and types of surgery in chronic pancreatitisShambhavi Sharma
This document discusses the role and types of surgery in chronic pancreatitis. It begins with an introduction and overview of chronic pancreatitis and its causes. It then discusses the various symptoms and complications that can arise. The document outlines the surgical and non-surgical management options, including drainage procedures like Puestow's procedure and resection procedures like pancreaticoduodenectomy. It provides details on the indications, advantages, and disadvantages of different surgical procedures. The key message is that surgery aims to relieve pain and complications while preserving pancreatic function as much as possible.
This document discusses the surgical management of acute pancreatitis. There are several indications for surgical intervention including diagnostic uncertainty, non-pancreatic causes like perforated viscus, infected necrosis, severe sterile necrosis, and symptomatic organized pancreatic necrosis. Infected pancreatic necrosis requires surgical debridement to treat as mortality is 100% if left untreated. Severe sterile pancreatic necrosis may also require surgery if the patient deteriorates or develops infection. Surgical procedures discussed include cholecystectomy, ERCP, CBD exploration, pancreaticojejunostomy, pancreatic resection, pancreatic debridement, and drainage of pancreatic abscesses.
A brief in esophageal caustic injury for surgical residentsHappyFridayKnight
This document provides information on esophageal caustic injury for surgical residents. It discusses the clinical manifestations of corrosive ingestion including hoarseness, dysphagia, and pain. Complications include short-term risks like perforation and long-term risks like stricture formation. It describes the pathophysiology of injury depending on substance pH and outlines investigations including endoscopy to assess injury severity. Management involves initial stabilization, monitoring based on injury grade from endoscopy, and later treatment of strictures with dilation or surgery if dilation fails.
Oesophageal cancer is a disease that affects the esophagus. The document provides details about:
1) The anatomy, histology, blood supply, lymphatic drainage and functions of the esophagus.
2) Risk factors, symptoms, epidemiology, macroscopic and microscopic appearance of oesophageal cancer.
3) Diagnostic tests and staging of oesophageal cancer including endoscopy, imaging, and biopsy.
4) Treatment options for oesophageal cancer including surgery, chemotherapy, radiation therapy and palliative care based on the cancer stage. Prognostic factors and performance status scales are also discussed.
The document discusses surgical management of chronic pancreatitis. It describes various surgical procedures for treating chronic pancreatitis including resection procedures like Whipple procedure, drainage procedures like Puestow's procedure, and hybrid procedures like Frey procedure. Studies have shown that duodenum-preserving pancreatic head resection procedures and longitudinal pancreaticojejunostomy provide better postoperative outcomes and pain control compared to resection procedures while preserving exocrine and endocrine function. The document concludes that surgery is effective for relieving pain in chronic pancreatitis and duodenum-preserving pancreatic head resection procedures have advantages over other surgical options.
Pancreatico-pleural fistula occurs when pancreatic secretions drain directly into the pleural cavity, often as a complication of pancreatitis or pancreatic trauma. Patients typically present with pulmonary symptoms like cough and dyspnea rather than abdominal pain. Diagnosis involves detecting high amylase levels in pleural fluid. Treatment begins conservatively with thoracentesis and octreotide to reduce secretions, but refractory cases may require ERCP with stenting or pancreatic surgery to relieve duct obstructions causing the fistula. While difficult to treat, identifying the condition helps avoid delayed diagnosis and directs management toward minimizing pancreatic stimulation and draining associated fluid collections.
The document summarizes the surgical management of chronic pancreatitis. It describes various procedures including drainage procedures like Puestow and Partington & Rochelle procedures, and resective procedures such as duodenum-preserving pancreatic head resection (DPPHR), Frey procedure, and Whipple procedure. It compares these procedures in terms of indications, advantages, disadvantages, postoperative outcomes based on randomized controlled trials. The optimal treatment depends on the severity and location of disease.
Benign tumors of the esophagus include leiomyomas, cysts, and polyps. Leiomyomas are the most common benign tumor, usually occurring in the lower two-thirds of the esophagus in males. Esophageal cysts often present in childhood and are located along the right side. Malignant esophageal tumors are usually advanced at diagnosis and involve the muscular wall. Squamous cell carcinoma is most common and risk factors include smoking and alcohol. Diagnosis involves endoscopy with biopsy and imaging such as CT scan. Treatment options include surgery, chemotherapy, and radiation, but long-term survival remains low given late-stage presentation.
This document discusses chronic pancreatitis, including its definition, causes, symptoms, diagnostic tests, and surgical treatment options. It notes that chronic pancreatitis is characterized by irreversible morphological changes and permanent loss of pancreatic function. The main indications for surgery are intractable pain and complications. Surgical options include drainage procedures like longitudinal pancreaticojejunostomy or cyst-enterostomies, as well as resections like Whipple procedure or distal pancreatectomy. The goals of surgery are pain relief, control of complications, and improved quality of life. While surgery provides sustained pain relief in over 85% of patients, outcomes may be complicated by associated issues like portal hypertension.
Surgical management of chronic pancreatitis.PritamMandal18
Chronic pancreatitis is characterized by irreversible damage to the pancreas from chronic inflammation and scarring that results in loss of exocrine and endocrine function. Risk factors include alcohol use, genetics, and recurrent acute pancreatitis. Diagnosis involves history, labs, imaging, and function tests. Management is initially conservative but may include endoscopic or surgical interventions for pain relief, complications, or disease progression. Surgical options include drainage procedures or resections, with randomized trials showing various techniques have comparable outcomes.
Post ERCP tension pneumo-thorax a rare complication Ibrahim Masoodi
A 65-year-old female presented with right upper quadrant pain and vomiting for 5 days. Imaging showed CBD stones. During a difficult ERCP involving pre-cut sphincterotomy, the patient developed tension pneumothorax. Exploration found a duodenal tear that was repaired. Tension pneumothorax is a rare but serious complication of ERCP due to retroperitoneal or intraperitoneal air dissection through diaphragmatic pores. Immediate diagnosis and treatment is needed to prevent hemodynamic compromise.
reviewed the literature ;Multidisciplinary management of gastric cancer
Yixing Jianga and Jaffer A. Ajani
; pictures taken from Sabiston textbook of surgery.
The document provides information on gastric carcinoma, including the anatomy and blood supply of the stomach, risk factors, clinical presentation, investigations, staging, and treatment approaches. It describes the layers of the stomach and how cancer spreads. Treatment may include surgery such as total or subtotal gastrectomy, or palliative procedures. Chemotherapy regimens are discussed for neoadjuvant, perioperative, and advanced settings. Staging guides treatment selection and prognosis.
Gastric cancer is the sixth most common cancer and third leading cause of cancer death worldwide. Risk factors include infection with H. pylori bacteria and low fruit/vegetable intake. Precancerous conditions include atrophic gastritis and intestinal metaplasia. Diagnosis involves endoscopy with biopsy. Treatment options include surgery to remove all or part of the stomach, chemotherapy, and radiation therapy. Post-operative care focuses on managing complications and preventing issues like dumping syndrome.
Stage III colon cancer denotes lymph node involvement. Standard treatment options include surgery for wide resection and anastomosis as well as adjuvant chemotherapy. Patients with one to three involved nodes have a significantly better survival rate than those with four or more involved nodes. Stage IV colon cancer denotes metastatic disease. Treatment may include surgical resection of primary lesions or metastases in selected cases, palliative radiation or chemotherapy, and clinical trials of new drugs or therapies. Survival rates vary significantly depending on stage, from 92% for stage I to 11% for stage IV colon cancer.
This tumor board conference discussed the case of a 70-year-old male who presented with gradual abdominal distention. Imaging and biopsy revealed a large intra-abdominal mass arising from appendiceal mucinous neoplasm. The conference objectives were to discuss the patient's presentation, workup, and treatment options for appendiceal mucinous neoplasm. Key points included the classification, clinical presentation and risk stratification of patients for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, which can provide benefits for select patients with appendiceal mucinous neoplasms and peritoneal surface malignancies.
Colon cancer can develop due to chromosomal instability or microsatellite instability. Presentation may be asymptomatic, or include changes in bowel habits, blood in stool, weight loss, or abdominal masses. Diagnosis involves tests such as colonoscopy, biopsy, and imaging. Treatment depends on stage and includes surgery to remove the cancerous section of colon as well as nearby lymph nodes, with the possibility of additional chemotherapy or radiation. Recurrence is common within the first few years and is monitored through cancer antigen testing, imaging and colonoscopy surveillance.
Colon and rectal cancer are the 3rd leading cause of cancer death in men and women. Risk factors include genetic predisposition, inflammatory bowel disease, tobacco use, sedentary lifestyle, obesity, diet, and family history. Screening is recommended starting at age 50, or earlier for those with risk factors. Treatment depends on the cancer stage and may involve surgery, radiation, chemotherapy, or a combination. The prognosis depends on stage, extent of disease, and ability to completely remove the cancer.
Gastric cancer refers to cancers occurring in the stomach. It is associated with risk factors like consumption of foods high in nitrates and Helicobacter pylori infection. Early stage disease is often asymptomatic, while late stage can present with weight loss and vomiting due to gastric outlet obstruction. Adenocarcinoma is the most common type. Treatment involves endoscopic or surgical resection, with chemotherapy sometimes used before or after surgery depending on staging. Complications include malignant acanthosis nigricans and postgastrectomy syndromes related to resorption, anastomosis, or motility issues. Prognosis is best for early gastric cancer but poor once metastases or peritoneal carcinomatosis occur.
Gastric cancer refers to cancers occurring in the stomach. It is associated with risk factors like consumption of foods high in nitrates and Helicobacter pylori infection. Early stage disease is often asymptomatic, while late stage can present with weight loss and vomiting due to gastric outlet obstruction. Adenocarcinoma is the most common type. Treatment involves endoscopic or surgical resection, with chemotherapy sometimes used before or after surgery depending on staging. Complications include malignant acanthosis nigricans and postgastrectomy syndromes related to resorption, anastomosis, or motility issues. Prognosis is best for early gastric cancer but poor once metastases or peritoneal carcinomatosis occur.
Peptic Ulcer Disease is caused by stomach acid and pepsin damaging the stomach or duodenal lining. Risk factors include H. pylori infection, smoking, NSAIDs, and age. The two main types are gastric and duodenal ulcers. Patients may experience abdominal pain or bleeding. Diagnosis involves endoscopy, biopsy, and breath testing. Treatment focuses on eradicating H. pylori, reducing acid with PPIs or H2 blockers, and surgery for complications. Lifestyle changes and multi-drug antibiotic regimens are effective at curing ulcers and preventing recurrence.
Peptic Ulcer Disease is caused by stomach acid and pepsin damaging the stomach or duodenal lining. Risk factors include H. pylori infection, smoking, NSAIDs, and age. The two main types are gastric and duodenal ulcers. Patients may experience abdominal pain or bleeding. Diagnosis involves endoscopy, biopsy, and breath testing. Treatment focuses on eradicating H. pylori, reducing acid with PPIs or H2 blockers, and surgery for complications. Lifestyle changes and multi-drug antibiotic regimens are effective at curing ulcers and preventing recurrence.
1. Carcinoma of the stomach and duodenal ulcers were discussed. Carcinoma of the stomach is the 5th most common cancer worldwide and incidence increases with age. Risk factors include H. pylori infection and diet. Treatment involves surgical resection if non-metastatic or palliative chemotherapy/radiation for advanced disease.
2. Duodenal ulcers are most commonly located in the bulb and caused by H. pylori infection. Patients present with epigastric pain relieved by food. Treatment involves acid-suppressing drugs like PPIs, H2 blockers, or surgery for complications. Recurrence can be prevented by H. pylori eradication.
3.
- Gastric cancer is a major cause of cancer mortality worldwide, though prognosis has improved with early detection and treatment. Incidence varies globally, being highest in Eastern Europe, Japan, and some parts of China.
- Risk factors include H. pylori infection, pernicious anemia, gastric polyps, and surgery for peptic ulcers or gastric reflux. Symptoms include abdominal pain, vomiting, anemia, weight loss, and obstruction.
- Treatment depends on cancer staging and may include radical surgery such as total or subtotal gastrectomy, chemotherapy, and radiation therapy. Complications of surgery can include leakage, fistula formation, and obstruction.
1) Gastric cancer is most common in Japan and China and generally affects the elderly. Risk factors include diet, H. pylori infection, and family history.
2) The majority of gastric cancers are adenocarcinomas. Early gastric cancers are usually cured by resection, while advanced cancers have a poor prognosis.
3) Treatment involves surgical resection with lymph node dissection. The extent of lymphadenectomy depends on the region, with D2 dissection being standard in Asia.
Pathology and Management of Malignant ascitesOladele Situ
This document discusses the pathology and management of malignant ascites. It begins with an introduction and overview of the relevant anatomy and pathophysiology. It then discusses the diagnosis of malignant ascites through history, physical exam, laboratory tests, imaging, and biopsy. Medical management options discussed include diuretics, octreotide, and newer biologic agents. Minimally invasive techniques include intra-cavitary agents like chemotherapy and radioactive isotopes. Surgical options include shunting procedures like peritoneo-venous shunts and cytoreductive surgeries. Overall, the document provides a comprehensive overview of the evaluation and treatment approaches for malignant ascites.
Colon cancer develops when healthy cells in the colon develop genetic mutations, causing abnormal cell growth. Risk factors include older age, family history, inflammatory bowel diseases, obesity, smoking, and a diet low in fiber and high in fat. Symptoms include changes in bowel habits, rectal bleeding, and abdominal discomfort. Diagnosis involves medical history, physical exam, colonoscopy, and biopsies. Treatment may include surgery to remove the cancerous tissue, chemotherapy, and radiation therapy. Supportive care focuses on relieving pain and improving quality of life.
Colorectal cancer risk factors include increasing age, family history, previous colon cancer, alcohol consumption, smoking, obesity, inflammatory bowel disease, and diet high in fat and protein with low fiber. Symptoms include changes in bowel habits and blood in stool. Diagnosis involves abdominal and rectal exams, stool tests, imaging like barium enema and colonoscopy. Treatment depends on stage and includes surgery to remove the tumor, chemotherapy, radiation, and management of complications like colostomy. Nursing focuses on nutrition, hydration, pain management, emotional support, and helping patients adjust to changes from surgery.
This case report describes a 52-year-old male farmer who presented with abdominal pain and bleeding for several months. Imaging revealed multiple liver abscesses and a mass arising from the second part of the duodenum. Biopsy of the mass during endoscopy indicated adenocarcinoma. The patient underwent a Whipple procedure where a 6x5cm mass was removed. Post-operative biopsy found it to be a malignant gastrointestinal stromal tumor (GIST). The patient was referred for chemotherapy. GISTs of the duodenum are rare but often diagnosed via endoscopy with biopsy. Surgical resection is the main treatment but imatinib may help downstage tumors for less invasive surgery or as adjuvant therapy.
The document discusses carcinoma of the esophagus, including its: anatomy and physiology; definition; types and stages; causes and pathophysiology; risk factors; clinical manifestations; diagnostic findings; medical and surgical management; nursing management; rehabilitation; and health teaching. Carcinoma of the esophagus can cause dysphagia, pain, and bleeding. It is most commonly adenocarcinoma or squamous cell carcinoma. Treatment may include chemotherapy, radiation, stent placement, or esophagectomy depending on the stage. Nursing care focuses on nutrition, symptoms management, education, and psychological support.
Chronic venous disease (CVD) refers to abnormalities of the venous system that are long-lasting in nature and may cause signs or symptoms. CVD ranges from varicose veins to more advanced chronic venous insufficiency. Risk factors include age, female sex, obesity, prolonged standing, family history, and parity. The venous system consists of superficial veins like the great saphenous vein and deep veins like the femoral vein. Pathophysiology involves valve incompetence and reflux in the superficial system and obstruction or reflux in the deep system. Clinical presentation varies but includes heaviness, aching, cramps, and skin changes classified from C1 to C6. Investigation involves duplex ultrasound scanning and treatment options range from compression
1. Abdominal vascular injuries can be lethal due to hemorrhage. Management may include non-operative, endovascular, or operative approaches.
2. Blunt injuries often cause retroperitoneal hematomas in four zones, while penetrating injuries usually require opening the hematoma.
3. Most arterial injuries can be repaired, while venous injuries can often be ligated if extensive, with monitoring for sequelae.
The document discusses trauma to the pancreas. It begins with an overview of pancreatic anatomy and mechanisms of injury. It then describes the clinical presentation and methods for diagnosis of pancreatic trauma, including CT, MRCP, and ERCP. The document outlines a proposed revised grading system for pancreatic injuries from Grade I to V. It concludes with a discussion of management strategies depending on the grade of injury, including expectant management, surgery such as distal pancreatectomy or pancreaticoduodenectomy, and complications.
1) Duodenal trauma can present during laparotomy or be detected on CT scans. Isolated duodenal hematomas may be managed non-operatively with NG tube and TPN.
2) Operative procedures for duodenal trauma include duodenal repair and ancillary procedures like periduodenal drainage and feeding jejunostomy.
3) Complications include duodenal fistula and increased morbidity with major vascular injury, pancreatic injury, or injury-operation delay over 24 hours. Overall mortality is usually due to major vascular injury and ranges from 5-30%.
Breast cancer is a disease where breast cells grow out of control, and is one of the leading causes of cancer death in women. Screening methods include mammography and ultrasound to check for abnormalities. The diagnosis involves a history, physical exam, imaging tests, and pathology to determine the stage. Treatment depends on the stage and includes surgery such as mastectomy or lumpectomy, radiation therapy, and systemic therapies like chemotherapy, hormone therapy, or targeted drugs.
This document provides information about the anatomy of the scalp and skull, including the layers of the scalp and the structures underneath. It also references sources that describe the brain's ventricular system and how to interpret CT scans of the brain, noting some types of injuries that may appear such as epidural hematoma, subdural hemorrhage, subarachnoid hemorrhage, cerebral contusions, and intracerebral hemorrhages.
Cervical spine trauma can cause serious injuries to the vertebrae and spinal cord. A general surgeon provides an overview of cervical spine anatomy and classifications of injuries. Key points include that the cervical spine is made up of 7 vertebrae and has significant lordosis. Injuries are evaluated based on clinical exam, imaging, and stability classifications. Common injuries discussed are craniovertebral junction injuries, axis fractures, and subaxial cervical injuries. Initial management focuses on immobilization and identification of neurological deficits, while treatment depends on the injury and stability. Complications include spinal cord injury, which can impact respiratory and cardiovascular function.
1. The document outlines the steps for the primary and secondary survey in the initial assessment of a trauma patient. It includes assessing the airway, breathing, circulation, disability, and exposure (ABCDE) and describes adjuncts like monitoring, imaging, catheter placement, investigations and treatments.
2. The primary survey involves a rapid assessment of life threats and stabilization, including airway management, breathing and ventilation, hemorrhage control, neurological assessment, and environmental control.
3. After initial stabilization, the secondary survey involves a full head-to-toe examination, gathering a medical history, considering transfer, and continued monitoring of the patient.
This document discusses common findings on CT brain scans related to various head injuries, including extradural hematoma (EDH), subdural hematoma (SDH), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and brain contusions. It provides details on the visual appearance and timing of injuries, such as EDH appearing lens shaped in the acute phase, SDH potentially associated with bridging veins tears, and chronic SDH displaying septations.
This document outlines damage control surgery techniques for trauma patients. Damage control surgery aims to control hemorrhage and contamination through limited operations, followed by intensive care resuscitation and reoperation. Specific techniques are described for the thorax, vasculature, liver, pancreas, spleen, and hollow viscera. Temporary abdominal closure is commonly used to prevent abdominal compartment syndrome before planned reoperation and definitive repair. Complications of open abdomen like fluid/protein loss and intestinal fistula require careful management.
This document provides an overview of pelvic fractures, including:
1. Classification systems for pelvic fractures including the Tile and Young-Burgess systems.
2. Diagnosis involves a history of traumatic injury and physical exam to check for signs of bleeding from the pelvis. Imaging of the pelvis is also used.
3. Management focuses on reducing pelvic volume to control bleeding through techniques such as pelvic binding, preperitoneal pelvic packing, external fixation, and angiographic embolization.
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and preventable cause of hospital death. VTE results from an interaction between venous stasis, hypercoagulability, and endothelial injury. Risk factors include advanced age, immobilization, surgery, trauma, cancer, and genetic or acquired thrombophilias. DVT presents with leg pain, swelling, and discoloration while PE causes shortness of breath, chest pain, and potentially cardiovascular collapse. Diagnosis involves D-dimer testing, ultrasound for DVT, and CT pulmonary angiography for PE. Treatment includes anticoagulation with heparin, low
This randomized controlled trial compared two spontaneous breathing trial (SBT) strategies: a 2-hour T-piece trial versus a 30-minute trial with pressure support ventilation (PSV) of 8 cmH2O. The Kaplan-Meier curves showed a significantly higher rate of successful extubation, defined as being free of invasive ventilation for 72 hours, in the PSV group compared to the T-piece group. Reasons for reintubation were not significantly different between groups. While the T-piece SBT was less well tolerated, the PSV SBT of 30 minutes was sufficient to assess breathing ability without increasing post-extubation respiratory failure rates.
1) Variceal bleeding occurs in patients with cirrhosis and portal hypertension when enlarged veins in the esophagus or stomach (varices) rupture.
2) Management of variceal bleeding involves stabilizing the patient, performing endoscopy within 12 hours to identify varices, and administering vasoactive drugs to control bleeding along with antibiotics to prevent infection. Endoscopic variceal ligation or sclerotherapy can help stop active bleeding from varices.
3) For non-variceal upper GI bleeding, endoscopic treatment with adrenaline, coagulation, or clips is usually attempted first. Surgery may be needed for uncontrolled or recurrent bleeding after failed endoscopic attempts.
This document discusses guidelines for treating head and cervical spine trauma. The key points are:
1) The primary goals for head trauma are to prevent secondary brain injury through oxygenation and prompt transfer to a trauma center, with CT scans not delaying transfer.
2) Cervical spine injury must be considered in multiple trauma patients and immobilized to prevent neurological worsening. Indications for immobilization include altered mental status, spinal symptoms, or concerning mechanism of injury.
3) Imaging of the cervical spine depends on clinical decision tools, with CT preferred if available from occiput to T1; if CT is unavailable, plain films from these regions including swimmer's and odontiod views may be obtained initially.
This document provides information on various skin, soft tissue, and hand infections including severity classifications. It describes conditions like abscesses, folliculitis, furuncles, carbuncles, erysipelas, cellulitis, and necrotizing fasciitis. For necrotizing fasciitis, it emphasizes the need for aggressive and rapid treatment including emergent debridement and antibiotics to prevent high mortality rates. It also covers specific hand infections like paronychia, felon, pyogenic flexor tenosynovitis, and bursal infections.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
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The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
4. Signs and Symptoms
• None is specific but history and physical
examination would help
• Pain
• Weight loss
• Early satiety and anorexia
• Nausea and vomiting
• Bloating
• = dyspepsia or indigestion
5. Diagnostic Tests
• Esophagogastroduodenoscopy (EGD)
– Alarm symptoms indicated the need for EGD
• Weight loss
• Recurrent vomiting
• Dysphagia
• Anemia
• bleeding
– All patients with gastric cancer should have multiple
biopsy specimen both for ruling out gastric cancer and
urease test
– Complications: perforation, aspiration, and respiratory
depression
9. Diagnostic Tests
• CT and MRI
– For staging work up in patients with malignant
gastric tumor (M)
• EUS
– Local staging (T, N)
– Consider neoadjuvant chemoradiation in patients
with transmural/node positive
– Tumor confined to mucosa may be considered
EMR
11. Diagnostic Tests
• Gastric secretory analysis
– Intubation stomach and monitoring gastric acid
output
• Scintigraphy
– Evaluation of gastric emptying ingestion of a
test meal with isotopes and scanning patient
under a gamma camera
12. Diagnostic Tests
• Tests for Helicobacter pylori:
– H.pylori
• Etiologic association with PU, MALT, gastric cancer
– Urease test
– CLO test
14. Epidemiology
• Globally:
– 4th most common cancer type
– 2nd leading cause of cancer death
• 5-year survival rate is 27%
• 85% of gastric neoplasm (4% from lymphoma,
1% from malignant GIST)
15. Risk Factors
• Family history of gastric cancer
• Pernicious anemia
• High nitrates, salt, fat dietary
• H.pylori
• EBV
• genetic: p53, COX-2, E-caherin, c-erb B-2, APC
• Previous gastrectomy or gastrojejunostomy > 10 years ago
• Tobacco use
• Menetrier disease (massive gastric folds, excessive mucous production
with protein loss, little acid production)
• Familial polyposis
• Gastric adenomas
• HNPCC
• Atrophic gastritis, intestinal metaplasia, dysplasia
17. Factors decreasing risk of
gastric cancer
• Aspirin
• High fresh fruit and vegetable diet
• Vitamin C
18. Premalignant Conditions
• Polyps
– Benign gastric polyps: neoplastic (adenoma and
fundic gland polyp) and nonneoplastic
(hyperplastic, inflammatory, hamartomatous)
– Hyperplastic polyp >2cm: may harbor dysplasia or
CIS
– Polyp > 1 cm should be removed to confirm
diagnosis
19. • Atrophic gastritis
– Most common of precursor of gastric cancer
– Involved with H.pylori
• Intestinal metaplasia
• Gastric remnant cancer
Premalignant Conditions
20. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015.
21. Gross Morphology: Borrmann Classification
• Polypoid: intraluminal without ulcerated
• Fungating: intraluminal with ulcerated
• Ulcerative: mass in wall of stomach
– self-descriptive
• Scirrhous: mass in wall of stomach
– Linitis plastica
– Infiltrate entire thickness of stomach
– Cover a very large surface area
– Poor prognosis
22. Brunicardi FC et al. Schwartz’s Principles of
Surgery. 10th ed. McGraw-Hill Education, 2015.
23. Histology
• Lauren classification
– Intestinal type
• Less aggressive
• Well-differentiated
• More common in older patients
– Diffuse type
• Poor-differentiated
• Younger patients
• Proximal tumor
26. Clinical Manifestation
• Physical examination typically is normal
• Weight loss
• Decreased food intake due to anorexia and early satiety
• Abdominal pain
• Nausea, vomiting, bloating
• Acute GI bleeding
• Chronic occult blood loss
• Dysphagia
• Aspiration pneumonia in a patient with vomiting and
obstruction
• Signs of metastases: Virchow’s node, Sister May-Joseph
nodule, Blumer’s shelf
27. ESMO guidelines committee. Gastric cancer: ESMO clinical practice guidelines for diagnosis, treatment, and follow-
up. Ann Oncol. Downloaded from http://annonc.oxfordjournal.org/ by guest on January 7, 2017.
28. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015.
29. Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill Education, 2015.
30. Brunicardi FC et al. Schwartz’s Principles of Surgery.
10th ed. McGraw-Hill Education, 2015.
31. • Early gastric cancer = cancer confined to
mucosa or submucosa = T1a
32. Screening
• Is effective in high-risk population
– FAP
– HNPCC
– Gastric adenoma
– Menetrier disease
– Intestinal metaplasia or dysplasia
– Remote gastrectomy or gastrojejunostomy
33. Treatment Principles
• Surgical resection is the only curative treatment
• Gross margin:
– 5 cm between tumor and gastroesophageal junction
(ESMO)
– 8 cm in diffuse cancer (ESMO)
– Proximal margin of at least 3 cm is
recommended for T2 or deeper tumors with an expansive
growth pattern (types 1 and 2) and 5 cm for those with an
infiltrative growth pattern (types 3 and 4) (Japanese 2014)
• At least 15 lymph nodes
• Multidisciplinary is mandatory
35. Japanese gastric cancer association. Japanese gastric cancer treatment guidelines 2014 (ver.4). Gastric
Cancer (2017) 20:1-19.
36. Definitions of Gastric Surgery
• Standard gastrectomy: at least 2/3 of stomach
+ D2 LN dissection
• Non-standard gastrectomy: altered according
to tumor stage
• Modified surgery: the extent of gastric/LN
resection is reduced from standard
• Extended surgery: gastrectomy combined with
– Adjacent involved tissue
– Extended lymphadenectomy
37. • Palliative surgery:
– Relieve symptoms: bleeding, obstruction in
advanced/metastatic disease
– Gastrectomy or gastrojejunostomy
– Stomach-partitioning gastrojejunostomy: superior
to simple gastrojejunostomy
• Reduction surgery: no evidence support
(REGATTA, JCOG705/KGCA01)
Definitions of Gastric Surgery
39. Extent of Gastric Resection
• Total gastrectomy: total resection including cardia and
pylorus
• Distal gastrectomy:
– remove pylorus
– cardia is preserved
– Standard gastrectomy = 2/3
• Pylorus-preserving
• Proximal gastrectomy: resect cardia
• Segmental gastrectomy: preserve cardia and pylorus
• Local resection
• Non-resectional: bypass, gastrostomy, jejunostomy
40. Resection Margin
• T2 and deeper tumor:
– Expansive growth pattern: 3 cm
– Infiltrative growth pattern: 5 cm
• Examine proximal margin by frozen section when
the rules cannot be observed
• Tumor invading esophagus, 5-cm margin not
required but frozen section to ensure R0
resection
• T1: gross margin 2 cm
– Clip marking for unclear margin
41. Selection of Gastrectomy
• Standard gastrectomy for clinically node-positive
or T2 – T4a distal or total gastrectomy
– If R0: total gastrectomy does not provide additional
benefit
• Pancreatic invasion requiring
pancreaticosplenectomy necessitates total
gastrectomy
• Total gastrectomy with splenectomy: tumor along
greater curvature and harbor metastasis to no.
4sb LN
45. Japanese gastric cancer association. Japanese gastric cancer treatment guidelines 2014 (ver.4). Gastric
Cancer (2017) 20:1-19
46. Japanese gastric cancer association. Japanese gastric cancer treatment guidelines 2014 (ver.4). Gastric
Cancer (2017) 20:1-19
47. D2+ Lymphadenectomy
• The benefit of prophylactic para-aortic
lymphadenectomy is denied by JCOG9501
– Prognosis is poor
– Neoadjuvant chemotherapy followed by D2+ is
option
• Station 13 = M1
– But may be option for tumors invading duodenum
48. Japanese gastric cancer association. Japanese gastric cancer treatment guidelines 2014 (ver.4). Gastric
Cancer (2017) 20:1-19
49. • Differentiated type = papillary, tubular
adenocarcinoma
• Undifferentiated type = poorly differentiated
and signet-ring cell adenocarcinoma
50. Principles of Endoscopic Resection
• Considered in tumor with very low probability
of lymph node metastasis and are suitable for
en-bloc resection
• EMR = endoscopic mucosal resection
• ESD = endoscopic submucosal dissection
51. Indication for Endoscopic Resection
• Indication as a standard treatment
– Differentiated type
– UL –
– T1a
– Diameter ≤ 2 cm
52. Curative Resection
• All are fulfilled:
– En bloc resection
– Tumor size ≤ 2 cm
– Differentiated type
– pT1a
– Negative horizontal margin (HM0)
– Negative vertical margin (VM0)
– No lymphovascular invasion (ly(-), v(-))
53. After Endoscopic Resection…
• After curative
– Follow-up EGD q6-12months
• After non-curative
– Surgical treatment should be performed
– En bloc resection of a differentiated type with
HM1 as the only non-curative factor
– Piecemeal resection of differentiated type
satisfying all other criteria
55. Chemotherapy
• Indications from ACTS-GC trial as adjuvant
chemotherapy
– Pstage II, IIIA, IIIB, exclude II due to pT1/pN2-N3
– R0 gastrectomy with ≥ D2 gastrectomy
• Indications from ESMO 2016
– Stage ≥ 1B resectable
82. Distal Gastrectomy
• Billroth I gastroduodenostomy
• Billroth II gastrojejunostomy
• Roux-en-Y gastrojejunostomy
• Jejunal interposition
83. References
Brunicardi FC et al. Schwartz’s Principles of Surgery. 10th ed. McGraw-Hill
Education, 2015.
Yeo CJ et al. Shackelford’s surgery of alimentary tract. 7th ed. Philadelphia: Elsevier
Saunders, 2013.
Ma J, Shen H, Kapesa L, and Zeng S. Lauren classification and individualized
chemotherapy in gastric cancer. Oncol lett. 2016 May; 11(5): 2959–2964.
ESMO guidelines committee. Gastric cancer: ESMO clinical practice guidelines for
diagnosis, treatment, and follow-up. Ann Oncol. Downloaded from
http://annonc.oxfordjournal.org/ by guest on January 7, 2017.
Japanese gastric cancer association. Japanese gastric cancer treatment guidelines
2014 (ver.4). Gastric Cancer (2017) 20:1-19.
84. References
Berlth F, Bollschweiler E, Drebber U, Hoelscher AH, Moenig S. Pathohistological
classification systems in gastric cancer: Diagnostic relevance and prognostic value.
World J Gastroenterol. 2014 May 21; 20(19): 5679–5684.
Cameron JL, Cameron AM. Current Surgical Therapy. 11th ed. Philadelphia:
Elsevier, 2014.
NCCN. Gastric cancer. Ver3. 2016.
Yeo CJ et al. Shackelford’s surgery of alimentary tract. 7th ed. Philadelphia: Elsevier
Saunders, 2013.
Zinner MJ, Ashley SW. Maingot’s Abdominal Operation. 11th ed. McGraw-Hill’s
Access surgery.