Week 2.8 - Upper GI Surgery Flashcards
What 4 upper gastro intestinal surgeries will we cover?
oesophageal cancer
gastric cancer
anti-reflux
bariatric briefly
What is the incidence of oesophageal cancer?
raising rates. 3x higher in men.
What is the purpose of staging oesophageal cancer?
to see if its metastasised - curative or palliative
Which tests do we do for oesophageal cancer?
- CT
- PET CT to not miss metastasis
- EUS to stage further
What treatments would we offer for metastasised oesophageal cancer, or if a patient is unfit?
- stent for dysphagia
- palliative RT if dysphagia isnt as bad
- palliative chemo to prolong life
What is the estimated survival in metastasised oesophageal cancer?
6 months - 1year
What treatments would we offer for resectable oesophageal cancer? survival?
chemo then oesophagectomy. 30% 5YSR
What are 3 oesophagectomy approaches?
- ivor lewis - gold standard
- left thoracic-abdominal approach
- transhiatal
what conduit is used in oesophagectomy?
stomach or colon
What is the ivor lewis procedure?
- gastric mobilisation
- place feeding tube
- do right thoracectomy
- deflate right lung
- take out oesophagus
- do gastro-oesophageal anastamosis for conduit
What is the prevalence of gastric cancer?
no. is reducing and much fewer than oesophageal
What are risk factors for gastric cancer?
h.pylori, smoking, alcohol, smoked fish, cured meats
What are signs of gastric cancer?
red flag ALARMS signs. dyspepsia, anaemia, dysphagia, mass or melena, weight loss.
How do you investigate gastric cancer?
contrast endoscopy, CT, PET CT to diagnose and stage
How do you treat localised gastric cancer?
chemo and then subtotal or total gastrectomy using laporascopy or open surgery.
How do you treat metastasised gastric cancer?
palliative chemo to slow progression. possibly stenting for symptomatic relief.
How do you perform a gastrectomy?
remove part of whole stomach, connecting oesophagus to jejunum with 50cm. avoids reflux.
What are side effects of gastrectomy?
reduced capacity to eat so change eating habits - smaller meals more often. big nutritional change
What recovery is longer - oesophageal or gastric cancer?
oesophageal cancer much longer process.
What anti-reflux surgery is available?
usually caused by hiatus hernia. laparoscopic hiatus hernia repair and fundoplication
Who requires anti-reflux surgery?
people who’s symptoms aren’t relieved adequately by PPI’s or H2RA’s (omeprazole and ranitidine)
How do you determine if anti-reflux surgery is necassary?
do endoscopy, oesophageal pH study and manometry to get objective evidence.
How do you carry out a pH study?
24hrs with probe down nose to lower oesophagus. patient clicks button when feel symptoms. see if it matches with decrease in pH below 4.
Why do we carry out manometry in patients seeking anti-reflux surgery?
to rule out hypomotility disorder like achalasia
How long does hiatus hernia surgery last?
10 years only. effective in 85%. weight gain weakens it.
What is bariatric surgery?
weight loss surgery
