Gastric bipartition for palliative treatment of advanced stomach cancer

case report

Abstract

Introductions: Gastric Cancer (GC) is the fourth most commonly diagnosed cancer and the second leading cause of cancer death worldwide. Median survival rarely exceeds 12 months, and, in metastatic form, 5-year survival is less than 10%. Most patients present an advanced stage of the disease, often with obstructive and unresectable distal tumors, requiring palliative treatment, whose objective is to give the patient a higher quality of life. Case Report: A 59 years old male patient, retired, smoker, alcoholic. The patient went to the emergency room with post-prandial vomits, associated to epigastric pain and loss of approximately 8 kgs in the last 20 days. In the physical exam, a palpable mass was identified in the epigastrium and mesogastrium, painful and solid. The patient had as an initial diagnostic hypothesis of pyloric syndrome secondary to gastric neoplasia. CT scan of the abdomen showed presence of a solid expansive process, infiltrative, involving the gastric wall, in the antrum, inclusive promoting signs of liquid stasis. A heterogeneous nodule in contact with the inferior vena cava, with 1.1 x 0.9 cm in its biggest diameters. With the diagnosis of advanced gastric adenocarcinoma, with invasion of the inferior vena cava, pancreas and hepatic metastasis, with no curative surgical or oncological intervention, it was opted to feed the patient with parenteral nutrition. The surgical team opted for the gastric bipartition with gastrojejunostomy, open technique, with total surgical time of 90 minutes. Patient was discharged in the fourth POD, in good clinical conditions, good oral intake, with no nausea or vomits. The patient died 16 months after the surgery due to gastric hemorrhage secondary to the advanced tumor and sepsis. Conclusão: The technique of bipartition can be considered an effective and safe technique, providing fewer symptoms, such as nausea and vomiting, oral diet maintenance and quality of life for patients who doesn´t have a curative intervention.