Sleeve Gastrectomy As a Treatment for High Risk Elderly Patients With Gastric Neoplasms

José De Ribamar Saboia De Azevedo, MD, Aureo Ludovico Depaula, MD, Rafael Massao Da Silva Nagato, MD, Glória Maria Lucas Costa, MD, Leonardo Rocha Ferraz, MD. Private Clinic

 

GASTRIC NEOPLASMS ARE PREDOMINANTLY MALIGNANT, AND NEARLY 90 TO 95% OF THEM ARE ADENOCARCINOMAS. MALIGNANT DISEASES INCLUDING LYMPHOMAS, SARCOMAS, SUCH AS GIST AND LEIOMYOSARCOMA ARE LESS OBSERVED. THE TREATMENT OF GASTRIC NEOPLASMS MAY INVOLVE AN EXTENSIVE GASTRECTOMY, LYMPHADENECTOMY, CHEMOTHERAPY AND RADIOTHERAPY. MORE THAN 30% OF PATIENTS WITH GASTRIC CANCER ARE OLDER THAN 70 YEARS AND USUALLY CARRY MULTIPLE COMORBIDITIES WHICH MAY COMPROMISE THE SURGICAL OUTCOME. THIS VIDEO WITH THREE CLINICAL CASES ILLUSTRATES THE USE OF THE TECHNICAL STEPS OF SLEEVE GASTRECTOMY TECHNIQUE BASED ON OUR EXPERIENCE IN BARIATRIC SUGERIES, IN ELDERLY PATIENS WITH GASTRIC NEOPLASMS. THESE HIGH SURGICAL RISK PATIENTS WERE TREATED WITH ATYPICAL GASTRECTOMIES IN PATTERNS OF SLEEVE GASTRECTOMY. A LESS EXTENSIVE SURGERY REDUCES THE MORBIDITY AND THE MORTALITY. THE SHORT GASTRIC VESSELS ARE LIGATED ACCORDING TO THE TUMOR. THE MASS MUST BE TOTALLY SEEN. THERE ARE THREE HIGH SURGICAL RISK CASES WITH DIFFERENT HISTORIES. THE HISTOPATHOLOGIC EXAMS CONFIRMED A GASTRIC ADEOCARCINOMA, A GASTRIC LYMPHOMA AND A GIST. THE THERAPEUTIC RESULTS IN COMPARISON TO YOUNG PATIENTS ARE ACCEPTABLE AND DO NOT COMPROMISE THE ONCOLOGIC OUTCOME. SLEEVE GASTRECTOMY FOR THE TREATMENT OF OTHER GASTRIC PATHOLOGIES CAN BE SAFELY PERFORMED AS AN OPTION IN ATYPICAL RESECTIONS OF GASTRIC NEOPLASMS AND IN HIGH SURGICAL RISK PATIENTS. LESS EXTENSIVE SURGERY IN ELDERLY PATIENTS WITH COMORBID DISEASES IS JUSTIFIED BECAUSE THE LOWER RATE OF TUMOR RECURRENCE DOES NOT RESULT IN A REDUCED RATE OF GENERAL SURVIVAL, THEREFORE, NOT COMPROMISING THE ONCOLOGIC OUTCOME AND REDUCING THE MORBIDITY AND MORTALITY. OUTCOMES WERE EXCELLENT.


Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V075

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