Dados do Trabalho

Título

Antral tumor gastrectomy in a morbidly obese patient: a case report

Apresentação do caso

Female patient, 57 years old, hypertense, diabetic, with hypothyroidism and morbidly obese grade III (BMI 47), diagnosed with antral stomach adenocarcinoma. She presented dyspepsia associated with episodes of upper digestive hemorrhage 2 years ago. Endoscopy enabled the observation of ulcers and the presence of H. Pylori was confirmed. Microscopy revealed findings characteristic of a poorly differentiated adenocarcinoma with the presence of “signet ring” cells. She underwent a subtotal videolaparoscopy gastrectomy associated with lymphadenectomy and Roux-en-Y reconstruction. In the surgical risk assessment, she had BP 160 x 98 mmHg and fasting blood sugar test 279 mg / dL, in addition to dyspnea to moderate effort, requiring reassessment by transesophageal echocardiography and perfusion scintigraphy. The surgical procedure consists of performing a pneumoperitoneum through the incision in the Palmer point and starting the dissection and division of the gastrocolic ligament, continuing to the gastric fundus through the greater curvature with dissection of the hepatoduodenal ligament as well. This was followed by lymphadenectomy of the splenic artery and celiac trunk. Roux-en-Y reconstruction was performed with stapling and closure of the gastroenteroanastomosis and closure of the mesus gap, performed in a food loop and a biliopancreatic loop of approximately 80 and 40 centimeters, respectively. The surgical piece was removed en bloc, through a median supraumbilical incision. The patient had an uneventful postoperative period, with a loss of 10 kg in 45 days and evolved with no indication for adjuvant chemotherapy, only oncological follow-up.

Discussão

Stomach cancer is the second most prevalent cancer in the world and its incidence is quite variable. In Brazil, it is the third most frequent type among men and the fifth among women. Etiology is multifactorial, but Helicobacter pylori plays a significant role. Signet ring cells are typical of mucin-bearing adenocarcinomas and are present in several types of cancer, but mainly in gastric adenocarcinoma.

Comentários Finais

Laparoscopic gastrectomy is indicated as a safe and minimally invasive procedure in the treatment of non-metastatic gastric carcinomas. This case exposes the surgical approach of a patient with gastric adenocarcinoma with previous comorbidities that require many precautions in their management.

Palavras Chave

{Adenocarcinoma} {Morbidly obese} {Gastrectomy}