Question

60 years old male patient has antral carcinoma which is spreading to the head of the pancreas and multiple small metastasis to the right lobe of liver. What will be the best treatment?

• A. Whipple’s surgery
• B. Gastrectomy + Right lobectomy
• C. Gastrojejunostomy
• D. Palliative care

Answer 1

The Correct Option is C

Antral carcinoma, also known as distal gastric cancer, located in the antrum of the stomach, is generally managed based on its stage and extent of spread. In this scenario, the cancer is invasive, affecting adjacent organs, particularly spreading to the head of the pancreas and having metastases in the liver. These factors significantly impact the treatment decision.

Listed options:

• Whipple’s surgery involves resection of the pancreaticoduodenal region, typically indicated for pancreatic cancer, and would not address metastatic liver disease.
• Gastrectomy + Right lobectomy involves surgically removing the stomach and part of the liver, which is not viable given the metastases.
• Gastrojejunostomy is a surgical procedure creating a connection between the stomach and the jejunum, generally used to bypass gastric outlet obstruction.
• Palliative care focuses on symptom management and quality of life improvement rather than curative measures.

Given the patient's metastatic disease to the liver and spread to the pancreas, curative surgery is not viable. The goal is to manage symptoms, particularly if there's obstruction caused by the primary gastric tumor. Gastrojejunostomy serves this purpose, relieving symptoms and potentially improving the quality of life.

Thus, the most appropriate treatment considering the evidence is:

Gastrojejunostomy