Ambreen Mannan, Suhail Ahmed Soomro, Tek Chand Maheshwari, Muhammad Hussain Laghari.
Oesophageal & Gastric Carcinoma; Surgical Management - Experience At Isra University Hospital Hyderabad.
Professional Med J Jan ;24(8):1105-9.

Objectives: To know the frequency of gastroesophageal carcinoma and its management at Isra University Hospital Hyderabad Sindh. Study Design: Descriptive, Prospective. Place and Duration of Study: Isra University Hospital Hyderabad during the period of January 2014 to January2016. Patient and Methods: Fifty two patients with gastroesophageal malignancy were scrutinized for elective and emergency surgery according to the stage and tumor resectability & observed for postoperative complication rate. Data is prepared in SPSS version 17. Inclusion Criteria: Carcinoma of esophagus and stomach. Exclusion Criteria: Benign lesions of esophagus and stomach (Tuberculosis, Bourevet’s syndrome, Band of Ladd’s, Diaphragmatic Hernia, Phyto/Tricobezoar). Gastric outlet obstruction (GOO) caused by bilio pancreatic, retroperitoneal or abdominal wall mass. Results: Among fifty two patients 11(22%) were with carcinoma of esophagus and 41(78%) with carcinoma stomach causing GOO; accounting 38(73%) male & 14(27%) females with age range of 29-69 years. Major presenting complaints of carcinoma of esophagus were progressive dysphagia from solid to liquid with significant weight loss while history of heamatemesis was found in only two patients. Carcinoma stomach mainly presented with symptoms of gastric outlet obstruction (GOO); partial or complete I.e. vomiting, fullness and epigastric mass with weight loss. Out of total 52 patients; 35 were biopsied and staged preoperatively while 17 patients could not be biopsied before surgery either because of inadequate tissue specimen or scope negotiation problem. However after surgery their biopsy was found out malignant. All such patients were optimized before surgery for correction of hemoglobin, electrolyte imbalance and nutritional support Feeding jejunostom & gastrojejunostomy were mainly performed for carcinoma esophagus and stomach while for resectable tumors Ivor Lewis, McKeon or Billroth I or II were also performed according to the general patient condition and the local resectability of the tumor mass. Our post-operative complication rate was 26% and comprised nausea, vomiting, wound infection, and delayed gastric emptying which were treated conservatively. Our operative mortality was none. Conclusion: Most of our cases were in advanced stage of malignancy which was mainly dealt with Feeding jejunostomy & Gastrojejunostomy. However Esophagogastric intubation in advanced malignancy is the safe & effective alternative if available.

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