Răzvan Marius Ion, Mircea Mureșan, Daniela Sala, Simona Mureșan, Alexandra Scurtu, Radu Mircea Neagoe
Background: Gastric cancer is an important cause of death in worldwide, despite the progress achieved through screening programs. Multivisceral resections are dictated by R0 resection gold, but also by the histopathological type of the neoplasm involved.
Case report: A 64-year-old patient was admitted in Surgery department for epigastric abdominal pain, haematemesis, anorexia, weight loss. Superior digestive endoscopy revealed a reduced stomach in size, inextensible at insufflation, with a malignant ulceration, unresponsive to proton pump inhibitor (PPI) treatment. The clinical and endoscopic context required surgery and intraoperative it was detected a tumor block that includes the stomach, transverse colon, spleen and pancreas, undergoing total gastrectomy, distal spleno-pancreatectomy, subtotal colectomy with eso-jejunal anastomosis on Y Roux loop, ileo-sigmoid anastomosis, suture of the proximal pancreatic tissue. Postoperative course was favorable with discharge of the patient on the 11th postoperative day. The histopathological examination revealed a diffuse carcinoma with linitis plastica appearance. After oncological treatment with imatimib, no endoscopic and imagistic signs of tumor recurrence are seen at 6 months apart.
Conclusions: Multivisceral resections in the advance gastric cancer T4 stage represent the only surgical procedure to obtain an R0 type resection. This should be done whenever technically is possible, but favorable outcomes in distance survival are recorded in mesenchimal forms and less in adenocarcinomas.
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