Week 2.8 - Upper GI Surgery

Question 1

What 4 upper gastro intestinal surgeries will we cover?

Answer 1

oesophageal cancer
gastric cancer
anti-reflux
bariatric briefly

Question 2

What is the incidence of oesophageal cancer?

Answer 2

raising rates. 3x higher in men.

Question 3

What is the purpose of staging oesophageal cancer?

Answer 3

to see if its metastasised - curative or palliative

Question 4

Which tests do we do for oesophageal cancer?

Answer 4

• CT
• PET CT to not miss metastasis
• EUS to stage further

Question 5

What treatments would we offer for metastasised oesophageal cancer, or if a patient is unfit?

Answer 5

• stent for dysphagia
• palliative RT if dysphagia isnt as bad
• palliative chemo to prolong life

Question 6

What is the estimated survival in metastasised oesophageal cancer?

Answer 6

6 months - 1year

Question 7

What treatments would we offer for resectable oesophageal cancer? survival?

Answer 7

chemo then oesophagectomy. 30% 5YSR

Question 8

What are 3 oesophagectomy approaches?

Answer 8

• ivor lewis - gold standard
• left thoracic-abdominal approach
• transhiatal

Question 9

what conduit is used in oesophagectomy?

Answer 9

stomach or colon

Question 10

What is the ivor lewis procedure?

Answer 10

• gastric mobilisation
• place feeding tube
• do right thoracectomy
• deflate right lung
• take out oesophagus
• do gastro-oesophageal anastamosis for conduit

Question 11

What is the prevalence of gastric cancer?

Answer 11

no. is reducing and much fewer than oesophageal

Question 12

What are risk factors for gastric cancer?

Answer 12

h.pylori, smoking, alcohol, smoked fish, cured meats

Question 13

What are signs of gastric cancer?

Answer 13

red flag ALARMS signs. dyspepsia, anaemia, dysphagia, mass or melena, weight loss.

Question 14

How do you investigate gastric cancer?

Answer 14

contrast endoscopy, CT, PET CT to diagnose and stage

Question 15

How do you treat localised gastric cancer?

Answer 15

chemo and then subtotal or total gastrectomy using laporascopy or open surgery.

Question 16

How do you treat metastasised gastric cancer?

Answer 16

palliative chemo to slow progression. possibly stenting for symptomatic relief.

Question 17

How do you perform a gastrectomy?

Answer 17

remove part of whole stomach, connecting oesophagus to jejunum with 50cm. avoids reflux.

Question 18

What are side effects of gastrectomy?

Answer 18

reduced capacity to eat so change eating habits - smaller meals more often. big nutritional change

Question 19

What recovery is longer - oesophageal or gastric cancer?

Answer 19

oesophageal cancer much longer process.

Question 20

What anti-reflux surgery is available?

Answer 20

usually caused by hiatus hernia. laparoscopic hiatus hernia repair and fundoplication

Question 21

Who requires anti-reflux surgery?

Answer 21

people who’s symptoms aren’t relieved adequately by PPI’s or H2RA’s (omeprazole and ranitidine)

Question 22

How do you determine if anti-reflux surgery is necassary?

Answer 22

do endoscopy, oesophageal pH study and manometry to get objective evidence.

Question 23

How do you carry out a pH study?

Answer 23

24hrs with probe down nose to lower oesophagus. patient clicks button when feel symptoms. see if it matches with decrease in pH below 4.

Question 24

Why do we carry out manometry in patients seeking anti-reflux surgery?

Answer 24

to rule out hypomotility disorder like achalasia

Question 25

How long does hiatus hernia surgery last?

Answer 25

10 years only. effective in 85%. weight gain weakens it.

Question 26

What is bariatric surgery?

Answer 26

weight loss surgery