A 42-year-old woman had a choking sensation and foreign body sensation after eating for 2 months. The doctor initially suspected gastric cancer and performed gastroscopy, which revealed an elevated lesion about 2.5 cm in size at the entrance to the cardia of the stomach.
Surgery “first call” after early gastric cancer diagnosis
The patient underwent an abdominal CT, which did not reveal metastases elsewhere in the abdomen. The surgeon recommended surgery. The decision to perform a “major proximal gastrectomy” was made after intraoperative exploration.
The early symptoms of gastric cancer are often atypical, and those in the cardia sometimes cause choking after eating. For this type of tumor in the upper third of the stomach, the surgeon will usually choose either a proximal major gastrectomy or a total gastrectomy, depending on the location, size, and margins of the tumor. For relatively early tumors in the upper 1/3 of the stomach, there is no significant difference in the 5-year survival rate for patients who undergo proximal major gastrectomy compared to total gastrectomy, but the postoperative nutritional status is better. And given the small size of the tumor and the absence of lymph node metastases, the proximal major gastrectomy was chosen.
However, in progressive gastric cancer with relatively advanced disease, it has been suggested that the choice of proximal major gastrectomy can affect postoperative recurrence and long-term survival, possibly related to the lack of thoroughness of surgical resection.
After surgery, why is chemotherapy not necessary?
The patient’s postoperative pathology report suggested that the tumor infiltration was limited to the submucosa (stage T2), no metastasis in the lymph nodes (N0), and the pathologic stage of gastric cancer was stage IB.
The patient did not receive postoperative adjuvant chemotherapy, which is currently recommended in the Chinese Society of Clinical Oncology (CSCO) guidelines for postoperative adjuvant chemotherapy in patients with D2 surgery (lymph node dissection to the second station lymph nodes around the stomach) R0 resection (no residual cancer cells detected microscopically) and no preoperative treatment above T2 and/or N+, and for patients with stage I pathology postoperative adjuvant chemotherapy is not Adjuvant chemotherapy was recommended. This patient had a postoperative stage IB pathology and therefore was not treated with postoperative adjuvant chemotherapy.
However, it is important to note that patients need regular postoperative follow-up for early detection of possible recurrence or metastasis. It is recommended that patients be fully reviewed every 3 to 4 months for 2 years after surgery, every 6 months for 2 to 5 years, and annually after 5 years 1 review. The review includes a physical examination, testing for tumor-related markers [carcinoembryonic antigen (CEA), glycoprotein 19-9 (CA19-9, etc.)], chest X-ray, ultrasound, abdominopelvic enhancement CT (six months to one year), and gastroscopy (one time per year).