Abstract
BackgroundThe number of elderly patients with gastric cancer is increasing, with the very elderly often refusing radical gastrectomy with lymph node dissection. Such a patient presented to us and we proposed a palliative surgery involving gastric local resection using laparoscopy endoscopy cooperative surgery (LECS).Case presentationAn 89-year-old woman presented to our hospital with progressing anemia. She had an aortic arch replacement for aortic dissection 6 months previously and was taking antithrombotic drugs for atrial fibrillation. She was diagnosed with advanced gastric cancer, and we presented a radical resection treatment plan involving distal gastrectomy with lymph node dissection. However, she strongly refused undergoing radical gastric cancer resection. We believed that at least local control of the tumor could be effective in preventing future bleeding or stenosis due to tumor progression. Therefore, we proposed a local gastrectomy with LECS as an optional treatment, and she agreed to this treatment. The surgery was performed with minimal blood loss, and no postoperative complications were observed. Histopathological examination revealed a 45 × 31-mm, Type 2, poorly differentiated adenocarcinoma (pT4a, ly0, v1a), and the resected margin was negative. The patient was alive 2 years after surgery without apparent recurrence or other illness. In addition, her weight was maintained, together with her daily activity.ConclusionLocal resection of gastric cancer with LECS might be an option for the palliative treatment of patients who refuse radical resection of gastric cancer.
Highlights
The number of elderly patients with gastric cancer is increasing, with the very elderly often refusing radical gastrectomy with lymph node dissection
The postoperative complication rate appears to be high in elderly patients after gastrectomy [6, 7]
In this study, 2.6% of Stage I gastric cancer patients in this age group died due to a disease other than gastric cancer within 90 days after a radical gastrectomy [13]. These results show excessive surgical stress has a negative impact in terms of overall survival of patients who undergo radical gastrectomy for gastric cancer
Summary
Gastric cancer treatment guidelines are useful for treatment selection in patients with gastric cancer, sometimes they are not applicable to those with surgical risk factors or older patients who do not have a long life expectancy [1]. Computed tomography showed no lymph node swelling or distant metastases Her clinical diagnosis was AGC, L, Post, 40 mm, Type 2, por., cT4aN0M0, cStage IIB (UICC 8th Edition). The postoperative macroscopic and pathological diagnosis was a 45 × 31-mm, Type 2, poorly differentiated adenocarcinoma (pT4a, ly0, v1a), with no lymph node metastases (0/6) (Fig. 3). Six month post-surgery, her bodyweight was the same as before surgery, her hemoglobin was increased and maintained at 12, her serum albumin level was normal, and there was no recurrence on computed tomography She has survived for 2 years after surgery without obvious recurrence or other illnesses, and with no interference to her daily life or dietary intake
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