"I have a patient here and would like to invite you to assist in a consultation."
Wanting a dical student like her to assist in a consultation? Assisting in consultations usually involves low-ranking doctors first, and if unsatisfactory, higher-ranking doctors are called upon. Xie Wanying had every reason to think she misheard.
"It’s a patient with anastomotic leak after gastric cardia cancer surgery." Wei Guoyuan briefly introduced the case to help her understand why she was suddenly sought for assistance.
Gastric cardia cancer is often classified as stomach cancer dostically. Its incidence and mortality are calculated under stomach cancer statistics. Actually, it’s a junctional cancer. Anatomically speaking, the cardia is located at the junction of the esophagus and stomach, where tumors exhibit characteristics of both gastric cancer and esophageal adenocarcinoma. In the future, it will be more accurately defined in dicine as gastroesophageal junction cancer.
Concerning the treatnt of this disease, early tumors are small, similar to other tumors like intestinal cancer, and can be addressed in the Departnt of Gastroenterology using endoscopy. Tumors always adhere to the principle of early treatnt leading to better prognosis. Unfortunately, there is no habit of routine dical examination among the populace. Early-stage gastric cardia cancer symptoms closely resemble common gastrointestinal inflammation symptoms, and without endoscopy, differentiation is impossible. Many dostic patients are diagnosed at mid-to-late stages, suitable only for surgical intervention.
Both General Surgery and Thoracic Surgery can conduct surgical procedures for gastric cardia cancer. General Surgery typically performs open surgery without incising the diaphragm, partially removing the stomach and esophagus. Due to the limitations of abdominal surgery, residual tumors at the esophagus end and thoracic lymph nodes may not be thoroughly cleared, leading to easy recurrence. Thus, more people opt for Thoracic Surgery for this procedure. Thoracic Surgery involves entry through the thoracic cavity and then into the abdominal cavity, enabling a more thorough tumor clearance compared to General Surgery. However, it may lead to severe complications, such as compression of the heart and other organs, and postoperative thoracic anastomotic leaks.
The surgery for this patient was conducted at Xuanwu Hospital’s Thoracic Surgery. Although Xuanwu Hospital’s Thoracic Surgery is not particularly famous, it can certainly perform common tumor surgeries, possessing a certain level of technical proficiency. Hence, Xuanwu Hospital’s Neurology Departnt isn’t incapable of treating diseases; it can handle common illnesses. It’s just that in cases like Sister Seo’s severe acute injury, their technical capability is limited under the circumstances.
Postoperative anastomotic leak is a common surgical complication. Its causes are partly related to the Chief Surgeon’s technique and largely to the patient’s individual differences. Cases are seen across various surgical departnts at Guoxie. Handling anastomotic leaks has always been a major challenge for the surgical community. One must not therefore question the technical competence of Xuanwu Hospital’s Thoracic Surgery unless there’s an unusually high rate of leak cases in a surgical departnt.
Wei Guoyuan’s classmate, Doctor Shao Jialiang, who works in the sa hospital’s Thoracic Surgery, encountered such a case and initially considered consulting Gastro-Thoracic Surgery at Guo Zhi Hospital. Upon hearing, Wei Guoyuan suggested they consult Xie Wanying instead.
There are generally two ways to solve postoperative leaks: conservative treatnt or surgical treatnt. For surgical treatnt, one can conduct another surgery to reopen the cavity or utilize minimally invasive endoscopic surgery to seal the leak, typically handled by gastroenterology specialists.
Doctor Shao sought assistance from colleagues within the hospital’s internal dicine departnt. Xuanwu Hospital’s Gastroenterology, like its General Surgery, is more renowned and has this technical capability, but concluded that it was unfeasible.
Why? The patient has anastomotic stenosis, preventing the gastroscope from passing through.
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