Upper GI Surgery Flashcards
What are some examples of conditions that often require upper GI surgery?
Oesophageal cancer
Gastric cancer
Anti-reflux
Bariatric surgery
How does the incidence of oesophageal cancer compare between men and women?
3x higher in men
How many people with oesophageal cancer survive 10 years?
10%
Why is the prognosis of oesophageal cancer so poor?
Symptoms present late
What are common traits of people who end up getting oesophageal cancer?
Smoke
Eat little fruit and veg
Overweight
Drink alcohol
What are the 2 kinds of oesophageal cancers?
Adenocarcinoma
Squamous cell carcinoma
Where in the oesophagus does adenocarcinoma occur?
Distal oesophagus
What are risk factors for adenocarcinoma of the oesophagus?
Obesity
Gastro-oesophageal reflux (such as Barrett’s metaplasia)
Where in the oesophagus does squamous cell carcinoma occur?
Proximal and middle third
What are risk factors for squamous cell carcinoma of the oesophagus?
Smoking
Alcohol
Low socio-economic status
What are some symptoms of oesophageal cancer?
Frequent and persistent hiccups
Acid indigestion, heartburn and reflux
Difficulty when swallowing (dysphagia)
Constant burping, belching and coughing
Pain between the shoulder blades
Weight loss
What are very important symptoms for oesophageal acid?
Dysphagia and weight loss
What investigations are done for oesophageal cancer?
Endoscopy or contrast swallow
Why is endoscopy prefered to contrast swallow for investigating oesophageal cancer?
Can see if is benign or malignant by doing biopsy with endoscopy
What must be done once the diagnosis of oesophageal cancer is confirmed?
Stage the tumour
What staging is used for oesophageal cancer?
TNM staging
Explain the algorithm for staging oesophageal cancer?
1) CT scan of chest and abdomen
2) If metastatic/unfit then no further staging is required and palliative/supportive therapy is given
3) If resectable/fit an EUS is done for T/N staging and a PET CT for M staging
For staging, what is done after the CT of the chest/abdomen if the patient is fit?
EUS for T/N staging
PET CT for M staging
Why is a PET scan done for M staging?
Metastasis in small number of patients is not picked up by CT scan
How is a tumour seen on a CT scan?
Oesophagus should be black due to being full of air, tumour is a different colour
What does the T score of a tumour tell us?
How much the tumour has progressed through the mucosa into the muscle wall then otno the surface and perhaps surrounding structures such as lung or pericardium
What does the N score of a tumour tell us?
If the cancer has entered the lymph nodes
Do node positive or node negative tumours have a worse prognosis?
Node positive
What does M staging of a tumour tell us?
If metastasis are present
What are common metastasis from oesophageal cancer?
Lungs or liver
What are treatment options for oesophageal cancer for people who are metastatic/unfit?
Stenting (allows them to eat)
Palliative radiotherapy (increases length of life)
Palliative chemotherapy (increases length of life)
What needs to be considered when giving chemotherapy?
Side effects, sacrificing quality of life for more time
What are treatment options for oesophageal cancer for people who are resectable/fit?
Oesophagectomy and chemotherapy
Chemotherapy and radiology if concerns about fitness
What is the 5 year survival rate of someone who recieves an oesophagectomy and chemotherapy for oesophageal cancer?
45%
What is the 5 year survival rate for someone who recieves chemotherapy and radiotherapy for oesophageal cancer?
30%
What kind of cancer responds best to chemotherapy?
Squamous cell cancers
What are the different approaches for an oesophagectomy?
Ivor lewis
Trans-hiatal
Left thoraco-abdominal
What determines which approach is used for an oesophagectomy?
Where the tumour is, patient body size and how much access is needed
What is the operation called where part, or all, of the oesophagus is removed?
Oesophagectomy
What is the morbidity of an oesophagectomy?
20-30% (due to operating in the abdomen and the chest)
What is the mortality of an oesophagectomy?
5%
How long is required before someone who recieved an oesophagectomy returns to pre-op quality of life?
10 months
What is done in an oesophagectomy?
In the abdomen - gastric mobilisation
In the chest - oesophageal resection and gastro-oesophageal anastomosis
What happens to the patient after an oesophagectomy is done?
Goes to ICU for recovery, then to high dependancy unit where drains are taken out and can start eating from day 5
What day after an oesophagectomy can the patient start eating again?
Day 5
What are the most common cancers worldwide ranked from 1 to 5?
1) Lung
2) Breast
3) Colorectal
4) Prostate
5) Stomach
Rank the top 5 cancers for causing death?
1) Lung
2) Liver
3) Stomach
4) Colorectal
5) Breast
What is the overall survival rate of stomach cancer?
30%
What is the survival rate of stage IV stomach cancer?
4%
What are risk factors for stomach cancer?
Infection with helicobacter pylori
Alcohol
Smoking
Excessive consumption of salted fish, pickled vegetables and cured meats
What is the presentation of stomach cancer?
Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses and melaena/haematemesis
Swallowing difficulty
What pneumonic should be remembered for presentation of stomach cancer?
ALARMS
anaemia
loss of weight
anorexia
recent onset of progressive symptoms
masses and melaena/haematemesis
swallowing difficuly
What investigations are done for stomach cancer?
Endoscopy
Contrast meal
What staging is used to stage stomach cancer?
TNM
What is used to stage stomach cancer?
CT chest/abdomen
Laparoscopy
What is a surgical procedure that allows access to inside the abdomen and pelvis without having to make a large incision?
Laparoscopy
What surgery can be done to treat stomach cancer?
Subtotal gastrectomy or total gastrectomy and Roux en Y reconstruction
When can some of the stomach be left during a gastrectomy?
If the tumour is in the pyloric region
If the tumour is in the body of the stomach is a subtotal or total gastrectomy required?
Total gastrectomy, can only leave part of the stomach behind if the tumour is the pyloric region
Who plays a massive part in looking after patients after stomach surgery?
Dieticians
What are the two kinds of gastrectomy?
Laparoscopic distal gastrectomy
Open gastrectomy
What is a procedure where part or all of the stomach is removed?
Gastrectomy
What surgery is often done for GORD?
Anti-reflux surgery
What are common GORD symptoms?
Chest pain
Heartburn
Trouble swallowing
Sour taste in mouth
Wheezing, asthma symptoms, chronic coughing
Excessively salivating
Tooth erosion
Belching
What are examples of hernias that lead to GORD?
What investigations are done for GORD?
Endoscopy
Oesophageal pH studies and manometry
What can be some side effects of laparoscopic hiatus hernia repair and fundoplication?
Dysphagia
Difficulty to belch and vomit
Gas bloating
Excess flatulence
Diarrhoea
What is the procedure used to treat GORD caused by a hiatus hernia?
Laparoscopic hiatus hernia repair and fundoplication
What procedure is used to reduce the size of the stomach with a gastric band or through removal of a portion of the stomach?
Bariatric surgery
What BMI is considered to be overweight?
What BMI is considered to be Obesity I
What BMI is considered to be Obesity II?
What BMI is considered to be BMI III?
What what stage of obesity is obesity surgery required instead of conventional treatment?
Obesity II (>35)
Other than bariatric surgery what else can be done to treat obese people?
Consider hormonal aspects, where hormones that trigger hunger are switched off
