Exploring Alternatives to Gallbladder and Spleen Removal in Cancer Surgery

Emergency... Emergency... Emergency... Inquiry about recent surgical matters regarding [Grandma]?

My grandmother is about 70 years old and has recently been diagnosed with gastric adenocarcinoma.
There is a 5 cm tumor in her stomach.
The doctor has explained that they plan to remove her entire stomach, as well as the gallbladder and spleen.
The reasoning given by the doctor is that the gallbladder may develop stones in the future and that the spleen poses a risk of significant bleeding.
I would like to ask if there are any alternatives to removing the gallbladder and spleen.
I personally believe that the spleen is a very important immune organ.
Is there really no way to preserve the spleen? I feel helpless and hope the doctor can provide some assistance.

Xiao Hai, 20~29 year old female. Ask Date: 2007/04/11

Dr. Huang Zhihui reply Surgery

Based on your description, I suspect she may have a higher stage of the disease, which necessitates a total gastrectomy.
Since total gastrectomy can affect the physiological structural changes of surrounding organs, it may sometimes be necessary to remove the gallbladder and spleen as well.
The spleen may still have immune functions in younger individuals, but it has no significant function in older adults; therefore, its removal should not have adverse effects.
As for the treatment of gastric cancer, surgery remains the primary approach, and extensive resection is essential to prevent recurrence.
Other treatments are only adjunctive and cannot provide a cure.
However, whether a 70-year-old woman is suitable for such a major surgery depends on her overall health status.
You should have a detailed discussion with the attending physician regarding this matter.
The attending physician has the obligation to explain the reasons for the surgery, whether there are alternative treatments besides surgery, the extent of the surgery, possible postoperative complications, and sequelae in detail before the operation.
Each patient's condition is unique, and treatment strategies vary accordingly; thus, a one-size-fits-all approach is not applicable.
The above opinions are based on general circumstances.

Reply Date: 2007/04/11

More Info

When it comes to cancer surgery, particularly in cases involving the stomach, gallbladder, and spleen, the decision to remove these organs is often based on a combination of factors including the extent of the cancer, the potential for complications, and the overall health of the patient. In your grandmother's case, with a 5 cm gastric adenocarcinoma, the surgical team is likely considering the best approach to ensure complete removal of the cancer while minimizing the risk of recurrence and complications.

Understanding the Rationale for Organ Removal
1. Gallbladder Removal: The gallbladder is often removed during gastric surgeries, especially if there is a risk of gallstones forming post-operatively. After a significant portion of the stomach is removed, the digestive process changes, which can lead to bile salt imbalances and increase the likelihood of gallstone formation. This is a preventive measure to avoid future complications.

2. Spleen Removal: The spleen plays a crucial role in the immune system, filtering blood and helping fight infections. However, if the cancer is located near the spleen or if there is a risk of splenic involvement, surgeons may recommend its removal to ensure that all cancerous tissue is excised. Additionally, if there is a concern about excessive bleeding during surgery, removing the spleen can sometimes be a precautionary measure.

Alternatives to Organ Removal
While the removal of the gallbladder and spleen may seem drastic, there are a few considerations and alternatives that could be discussed with the surgical team:
1. Surgical Techniques: Minimally invasive surgical techniques, such as laparoscopic surgery, may reduce the need for extensive organ removal. Surgeons can sometimes use these techniques to access the stomach and surrounding organs while preserving more tissue.

2. Tumor Localization: If the tumor is localized and not invading surrounding structures, it may be possible to perform a partial gastrectomy (removal of only part of the stomach) without needing to remove the gallbladder or spleen. This would depend on the tumor's exact location and its relationship to these organs.

3. Preoperative Treatments: In some cases, neoadjuvant therapies (chemotherapy or radiation before surgery) can shrink tumors, potentially allowing for less extensive surgery. This approach can sometimes preserve surrounding organs.

4. Consultation with Specialists: It may be beneficial to seek a second opinion from another surgical oncologist or a multidisciplinary team specializing in gastrointestinal cancers. They may offer alternative perspectives on the necessity of removing the gallbladder and spleen.

5. Postoperative Management: If the spleen must be removed, patients can still lead healthy lives, although they may need vaccinations and antibiotics to prevent infections. Understanding the implications of organ removal can help in making informed decisions.

Conclusion
The decision to remove the gallbladder and spleen during gastric cancer surgery is complex and should be tailored to the individual patient's situation. While the concerns about the immune function of the spleen and the digestive implications of gallbladder removal are valid, the primary goal is to ensure the best possible outcome in terms of cancer control. Open communication with the surgical team about your concerns and exploring all available options is crucial. It is essential to weigh the risks and benefits of organ removal against the potential for cancer recurrence and complications.

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