Upper GI Surgery Flashcards
What types of gi cancers are there?
Adeno and squamous carcinomas
How are they investigated?
Endoscopy is gold standard.
Can be useful contrast swallows but more for benign
Oesophageal cancer. Then what?
Staging
Common metastatic sites for oesophageal cancer
Lung and liver
Fit and healthy, no metastatic obvious, what scans?
EUS (Eosophageal ultra sound) nodes etc - can stage T/N (Tumour size/Nodes affected)
PET CT - can stage M (Metastases)
Treatment options if metastatic/unfit
Stenting - keep oesophagus open, able to swallow.
palliative radiotherapy, palliative chemotherapy
Treatment options if resectable/fit
Oesophagectomy and chemotherapy 5 year survival approx 45%
Radical radio/chemo therapy 5 year survival approx 30%
Adenocarcinomas have bettwe outcomes with an oesophagealectomy and chemotherapy
Squamous cell carcinomas have simelar outcomes for radical or surgery. Radical is sometimes better because no surgery/invasiveness is required, so if concerns about resection/fitness and no metastatic disease.
What is used to replace oesophagus?
Stomach, colon
Morbidity/mortality oesophagectomy
Morbidity 20-30%
Mortality 5%
What is prehabilitatio?
Fitness before surgery
Nutrition, dietician, physical (5k), psychological,
What is Ivor Lewis op?
Abdomen incision, mobalise stomach, tube ready for chest
Then open up chest, move things around, chop out and attach stomach (gastro-oesophageal anastomisis)
Why is prehab imorirant for osophageal cancer surgery?
Help with recovery. Big big op
Gastric Cancer causes/modifiable factors
Helicobacter pylori infection,
Alcohol
Smoking/vaping
Excessive consumption of salted fish, pickled veg and cured meat
gastroesophageal reflux disease
Epstein Barr virus
Gastritis
Obesity
Weight loss surgery criteria (Bariatric)
Over 40 BMI
35-40 with comorbidity
What happens in a laparoscopic sleeve gastrectomy
Sleeve - cut out part of the stomach -
Gastric bypass - around stomach and straight to duodenum
What happens in a laparoscopic sleeve gastrectomy
Sleeve - cut out part of the stomach -
Gastric bypass - around stomach and straight to duodenum
Where are adenocarcinomas in oesophageal cancers usually found? What are they related to?
Found in the distal oesophagus
Related to obesity, gastro-oesophageal reflux (Barrett’s metaplasia, dysplasia -> carcinoma)
What is BArrett’s metaplasia?
metaplasia of the stratified squamous cells in the distal oesophagus to simple columnar and goblet cells)
where are Squamous cell carcinomas found and what are they related to?
Proximal and middle 1/3 oesophagus.
Related to:
-Smoking
-Alcohol
-Low socio-economic status
What are the warning signs of oesophageal cnacer?
Frequent and Persistant hiccups
Constant belchiung, coughing, burping
Difficulty swallowing
Acid indigstion /heartburn/reflux
Weight Loss
Pain inbetween the shoulder blades
What are the ALARM Symptoms of Stomach cancer?
A - naemia
L - oss of weight
A - norexia
R - ecent onset of progressive symptoms
M-asses and Melaena/haematemesis
S - wallowing difficulty
nvestigations for stomach cancer
Endoscopy, contrast meal
What are the 2 options for gastric cancer surgery?
Subtotal Gastrectomy (just less than the whole stomach, more if cancer at bottom of the stomach)
Total gastrectomy and Roux en Y reconstruction (More for if cancer towards the top of the stomach, whole stomach comes out, jejenum connected to oesophagus and duodenum feeds in bile etc)
WHat does laproscopic mean?
Keyhole/ smaller incisions (not opening up the whole stomach)
What type of hiatus hernia would you definitly want to oparate on?
Paraesophageal Hiatus Hernia
(Stomach startes to poke through another hole in the diphragm, can lead to suffocation)
Sliding Hiatus Hernia (Stomach starts to poke through the osophageal hiatus) - surgery is considered but not definate.
How is acid reflux investigated?
Endoscopy/Oesophageal pH Studies and Manometry (pH in end of oesophagus monitored, can see if symptoms occur at the same time (patient presses a button)
Side effects of laparoscopic hiatus hernia repair and fundoplication
Dysphagia
Difficulty to belch and vomit
Gas Bloating
Excess flatulence
Diarrhoea
