In clinical treatment, many patients will ask, “How to choose the surgery method when you have gastric cancer?” There are three types of surgery for gastric cancer: endoscopic resection, laparoscopic surgery and open surgery. As for which surgery method to choose, professional doctors will choose the treatment method that can ensure the efficacy and less trauma to the patient according to the patient’s condition, so patients do not need to worry too much.
Endoscopic resection is suitable for some early gastric cancers
Not all early gastric cancers can be resected endoscopically. According to the Consensus Opinion on the Diagnosis and Treatment of Early Gastric Cancer Endoscopic Resection in China formulated in 2014, we briefly introduce the types of early gastric cancers that can be resected endoscopically: less than 3 cm, well-differentiated intramucosal cancer, and less than 2 cm, well-differentiated submucosal cancer, these early gastric cancers can be resected endoscopically.
Patients with non-advanced stage and no metastasis can have open or laparoscopic surgery
For the treatment of gastric cancer, surgery is the only possible means of cure, but surgery is not the only treatment. At present, the treatment of gastric cancer is a comprehensive treatment mainly based on surgery. In addition to surgery, patients also need chemotherapy, radiotherapy, Chinese medicine treatment, etc. Except for patients who can undergo endoscopic resection as mentioned above, the remaining gastric cancer patients without spread and metastasis can undergo laparoscopic surgery or open surgery as long as their bodies allow.
Open surgery or laparoscopic surgery, what should I choose?
The choice of open or laparoscopic surgery depends mainly on the disease progression, that is, the indications for laparoscopic surgery for gastric cancer. (If the indications for laparoscopic surgery are met, laparoscopic surgery will be performed, and if not, open surgery will be performed).
These conditions occur, which are more suitable for open surgery.
(i) The tumor is particularly large, with a diameter greater than 10 cm.
(2) The lymph nodes around the tumor are widely fused (in common parlance, the lymph nodes are stuck together), or the tumor is encircling blood vessels.
③The tumor has invaded other surrounding organs, and the tumor in the stomach needs to be removed together with the tumor in the surrounding organs.
Laparoscopic surgery can also be done when the patient is older and has combined chronic diseases
When the patient is older, 70, 80 or even close to 90 years old, laparoscopic surgery can be performed as long as the patient can tolerate the surgery. The biggest advantage of laparoscopic surgery is that it is minimally invasive, and the surgery has less impact on the patient’s cardiopulmonary function and the body’s stress response to the surgery is also less.
In addition, China has entered an aging society, and many patients have combined cardiovascular or pulmonary diseases, and some have even had coronary stenting. For patients with these conditions, surgeons will ask anesthesiologists and internists to make a comprehensive assessment, conduct a detailed examination of the patient, and do the appropriate treatment before surgery to reduce the risk of surgery, and then perform the surgery. These patients are given preference for laparoscopic surgery, which is less traumatic for the patient and results in faster postoperative recovery, and also reduces the corresponding complications.
Does poor lung function affect laparoscopic surgery?
Laparoscopic surgery involves filling the stomach with carbon dioxide gas to hold up an operating space for the surgery. Many patients worry, “My lungs are already bad, will I be worse off with the gas? From the surgeon’s point of view, if the patient cannot tolerate the pneumoperitoneum created by laparoscopic surgery, he or she will also face corresponding risks during open surgery. Therefore, for such patients, the doctor will perform pulmonary function tests before surgery, and if there is indeed a problem with pulmonary function, the appropriate treatment will be done before surgery, and the anesthesiologist or even the ICU doctor will be asked to help the patient perform pulmonary function exercises and apply medications to improve pulmonary function if necessary, before surgery!
Both surgical options are available, with limited choice of laparoscopic surgery!
Laparoscopic surgery is superior to open surgery in terms of short-term outcomes after surgery, postoperative gastrointestinal recovery time, time to eat, and early and late activity out of bed. In terms of long-term post-operative outcomes, there is no significant difference in five-year survival rates between laparoscopic and open surgery, and some studies suggest that laparoscopic surgery is superior to open surgery. So why not give priority to laparoscopic surgery?
Under which conditions, laparoscopic surgery should never be performed?
If preoperative examination reveals that the tumor invades surrounding organs, surrounding blood vessels, or if the tumor is larger than 10 cm, laparoscopic surgery is not allowed. In addition, if gastric cancer leads to gastric perforation or gastric bleeding (emergency surgery is required when gastric bleeding occurs), laparoscopic surgery should likewise be abandoned.
Why do some laparoscopic surgeries change to open surgery in the middle of the operation?
There is an inevitable problem that some laparoscopic surgeries may be temporarily converted to open surgery during the operation, which we call intermediate open surgery. First, it may be due to the condition. If the surgeon finds that the disease is more serious than the preoperative assessment when exploring the abdominal cavity with laparoscopy, such as the occurrence of lymphatic fusion wrapped around blood vessels, tumor invasion of surrounding organs requiring combined resection, etc., he will choose to convert to open laparotomy; the second reason may be a technical problem, such as the surgeon’s little experience in laparoscopic surgery and encountering some operations that may injure major blood vessels or organs during the operation. The second reason may be technical problems, such as the surgeon’s low experience in laparoscopic surgery and the possibility of injuring major blood vessels or organs during surgery.
It is not a double operation, it is just an extension of the laparoscopic incision. Therefore, it is important to perform an intermediate laparotomy in a timely manner to ensure the efficacy of the procedure.