The gastrointestinal tract
Martin Andrew Crook in Clinical Biochemistry & Metabolic Medicine, 2013
There may be some degree of malabsorption after gastrectomy. Rapid passage of the contents of the small gastric remnant into the duodenum may be associated with the following: The early dumping syndrome Soon after a meal, the patient may experience abdominal discomfort and feel faint and nauseated. These symptoms may be caused by the rapid passage of hypertonic fluid into the duodenum. Before this abnormally large load can be absorbed, water passes along the osmotic gradient from the extracellular space into the lumen. The reduced plasma volume causes faintness and the large volume of fluid causes abdominal discomfort.The late dumping syndrome (or post-gastrectomy hypoglycaemia) If a meal containing a high glucose concentration passes quickly into the duodenum, glucose absorption is very rapid, stimulating a surge in insulin secretion. The resultant ‘overswing’ of plasma glucose concentration may cause hypoglycaemic symptoms, typically occurring about 2 h after a meal. This is a form of reactive hypoglycaemia (see Chapter 12).
Gastric cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2014
Perhaps, the area of greatest controversy in the surgical management of patients with potentially curative gastric cancer is the extent of surgical resection required to achieve this goal. Most authorities would now agree that total gastrectomy is not always required if sufficient tumour clearance is possible without removal of the whole stomach. Similarly, routine removal of adjacent organs is only indicated where there is direct tumour extension into these, and even then the increased surgical morbidity must be balanced against the limited benefits in patients with such extensive disease. The upper GI surgical community is however divided in the attitude towards the extent of lymphadenectomy required in curative resections of the stomach. Meticulous mapping of lymph-node involvement for tumours in different anatomical locations within the stomach led to the concept of systemic lymph-node dissection in Japan.
Perioperative and Postoperative Deaths
Julian L Burton, Guy Rutty in The Hospital Autopsy, 2010
A detailed consideration of the various methods that can be employed in a total gastrectomy is beyond the scope of this chapter. Total gastrectomy is associated with a significant postoperative mortality. Fatal complications occur in approximately 6–14 per cent of patients and include dehiscence of the oesophagojejunal anastamosis with subsequent peritonitis, pneumothorax, hepatic necrosis resulting from ligation of the hepatic artery, and perforation of the jejunal loop by a feeding tube (Budišin et al., 2000). Death is more likely in patients aged over 40 years and in those with significant co-morbidities (Grossmann et al., 2002; Oňate-Ocaňa et al., 2007). The combination of pancreaticosplenectomy with gastrectomy increases the mortality rate (Lo et al., 2002).
Predictive value of nomogram based on Kyoto classification of gastritis to diagnosis of gastric cancer
Published in Scandinavian Journal of Gastroenterology, 2022
Jiejun Lin, Huang Su, Qingjie Zhou, Jie Pan, Leying Zhou
Cases of esophagogastroduodenoscopy at Wenzhou Central Hospital, Zhejiang University (China) from January 2019 to November 2019 were retrospectively collected. The inclusion criteria were as follows: referral for esophagogastroduodenoscopy, patients aged ≥ 18 years, with serum pepsinogen assay and confirmed histopathological diagnosis through endoscopic approach or surgery. The exclusion criteria were the history of surgical gastrectomy of gastric neoplasm. Of 16412 esophagogastroduodenoscopy cases from January 2019 to November 2019 at the Endoscopy Center of the Department of Gastroenterology, 13777 cases were excluded due to the lack of solid histopathological diagnosis or serum PGs and 2639 cases were enrolled in our study. The study protocol was approved by our ethical review board of Wenzhou Central Hospital, number L2021-03-001x.
Long-Term Outcome in Gastric Cancer Patients with Different Body Composition Score Assessed via Computed Tomography
Published in Journal of Investigative Surgery, 2021
Da Zhou, Ying Zhang, Xuejin Gao, Jianbo Yang, Guoli Li, Xinying Wang
According to statistics, in 2018, stomach cancer is the fifth most common malignancy in the world, after lung cancer, breast cancer, prostate cancer and colorectal cancer [1]. In China, the disease burden of gastric cancer is still relatively heavy, because 410,400 new cases of gastric cancer were diagnosed and 293,800 people died of gastric cancer in 2014 [2]. Currently, the main treatment for gastric cancer is surgery combined with chemotherapy, but the risk of serious complications and mortality after radical gastrectomy is high [3]. Clinical indicators such as age, comorbidities, and tumor stage had been considered to be prognostic factors of prognostic importance [4]. In recent years, more and more studies have shown that malnutrition is also an adverse factor affecting the prognosis and treatment effect of cancer patients. In addition, cancer patients, especially those with gastric cancer, had a higher risk of malnutrition, with about 19% of hospitalized patients receiving radical gastrectomy suffered from malnutrition [5–7]. Despite the constantly improved nutritional support technology and the concept of enhanced recovery after surgery [8,9], the incidence of malnutrition in gastric cancer patients is still high and patients with malnutrition have a poor prognosis and quality of life after surgery [10–12]. Hence, we need to better and faster identify malnourished patients in gastric cancer.
Effect of Oral Nutritional Supplementation on the Prognostic Nutritional Index in Gastric Cancer Patients
Published in Nutrition and Cancer, 2021
Kazuhiro Migita, Sohei Matsumoto, Kohei Wakatsuki, Tomohiro Kunishige, Hiroshi Nakade, Shintaro Miyao, Masayuki Sho
A total of 16 adverse events occurred during the administration of Racol® NF in 12 (26.1%) patients. These included abdominal fullness (n = 10), diarrhea (n = 2), nausea (n = 1), chest burn (n = 1), abdominal pain (n = 1) and urticaria (n = 1; Table 3). Two (4.3%) patients discontinued the intake of Racol® NF due to adverse events of diarrhea and urticaria. No severe adverse events were observed. Among the 46 patients, 31 (67.4%) patients underwent distal gastrectomy, 13 (28.3%) underwent total gastrectomy and one (2.2) underwent local resection of the stomach. One patient underwent only exploratory laparotomy because of peritoneal dissemination. Postoperative complications occurred in four (8.7%) patients. No mortality was observed.
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