Recently, the Affiliated Hospital of Jiangnan University broke through the "forbidden zone" of surgery for the elderly and successfully performed laparoscopic radical gastrectomy for a 96-year-old patient.
Old man Qiao (pseudonym) developed choking sensation after eating half a year ago. Gastroscopy and pathological examination showed: "cardia cancer". Because the tumor blocks the digestive tract, Mr. Qiao can only drink water to survive. He weighs only 45 kilograms. He also suffers from moderate anemia, hypoalbuminemia, and poor nutritional status. Patients and their families still hope that active treatment can be carried out through surgery to better improve the quality of life and extend the life cycle of .
Faced with the patient’s family’s earnest wishes and requests for help, Chief Physician Cao Huaxiang, deputy director of the Second Department of Gastroenterology, conducted an in-depth treatment evaluation and evaluated the surgical risks through multi-disciplinary joint diagnosis and treatment many times. Through careful and rigorous evaluation, the medical staff felt that there was still a chance for radical surgery, but what they needed to face were higher surgical risks and difficulties, more precise anesthesia management requirements, and more rigorous postoperative rehabilitation management.
Before the operation, the gastrointestinal surgery department, anesthesiology department, department of cardiovascular medicine, etc. conducted a multidisciplinary discussion and evaluation, and formulated a laparoscopic total gastrectomy surgical plan for the patient. They also conducted in-depth discussions on surgical risks, anesthesia management, correction of hypoalbuminemia, cardiopulmonary exercise, perioperative management and other issues, and made plans one by one for possible postoperative complications.
During the operation, the team found that the tumor involved the spleen, and splenectomy was required at the same time. Cao Huaxiang's team standardized the operation, performed precise anatomy, shortened the operation time as much as possible, completely removed the stomach and spleen, thoroughly cleaned out the metastatic lymph nodes, and completed the reconstruction of the digestive tract. The operation was successfully completed in more than two hours, with almost no bleeding during the operation. After the operation, the team used rapid recovery surgery (ERAS) for the elderly to help him successfully pass the dangerous period.
The successful implementation of this operation has raised the upper limit of the hospital's age limit for gastrointestinal malignant tumor surgery patients to 96 years old, reflecting the hospital's high-level perioperative management capabilities, marking another big step forward in multidisciplinary collaboration capabilities, and bringing good news to elderly patients.
Chief Physician Cao Huaxiang said that tumor surgery often discourages many surgeons because of its emphasis on radical cure, wide range of resection, and large surgical trauma. Elderly patients have degraded organ function, poor cardiopulmonary reserve, and relatively low tolerance for anesthesia and surgery. In recent years, with the application of a series of new technologies and concepts such as multidisciplinary diagnosis and treatment model (MDT), rapid recovery surgery (ERAS), and gastrointestinal micro and non-innovative surgical procedures, the elderly are no longer a "forbidden zone" for surgery. Through adequate preparation before surgery, mature surgical techniques, and collaborative cooperation among the anesthesiology department, operating room, and various departments, elderly patients can completely extend their survival and improve their quality of life through surgery. (Ji Nana)
proofreading Faye Wong
