Operability in carcinoma stomach is indicated by all except -
Ans. is 'd' i.e. Krukenberg tumor First read the below given lines from Schwaz & Bailey Schwaz writes "Surgical resection is the only curative treatment for gastric cancer and most patients with clinically resectable locoregional disease should have gastric resection. Obvious exceptions include patients who cannot tolerate an abdominal operation, and patients with overwhelming metastatic disease." Bailey writes "It is impoant that patients with incurable disease are not subjected to radical surgery that cannot help them. Unequivocal evidence of incurability is hematogenous metastasis, involvement of distant peritoneum, N4 nodal disease and disease beyond the N4 nodes, and fixation to structures that cannot be removed. It is impoant to note that involvement of another organ per se does not imply incurability, provided that it can be removed". About lymph nodes involvement and curability Schwaz writes ? "It should be strongly emphasized that many patients with positive lymph nodes are cured by adequate surgery. It should be stressed that after lymphnodes that appear to be involved with tumor turn out to be benign or reactive on pathological examination. Therefore therapeutic nihilism should be avoided, and in the low risk patients an aggressive attempt to resect all tumors should be made. The primary tumor may be resected en bloc with adjacent involved organs (eg. distal pancreas, transverse colon or spleen) during the course of curative gastrectomy. Palliative gastrectomy may be indicated in some patients with obviously incurable disease, but most patients presenting with stage IV gastric cancer can he managed without major operation." Thus any lymph node involvement is no indication against operation (except Bailey's N4 node and beyond. We are sorry, we don't know what this Bailey's N4 node means, but know this that Japanese have classified lymphnodes only upto N3 (Ref: Schwaz 9/e p933 (8/e p979) A solitary metastatic nodule in liver is also no indication against curable resection Krunkenberg's tumor i.e. metastasis to b/1 ovaries is indication against curable resection. But still here it should be remembered that even palliation in incurable cases is best achieved by surgical resection.
Involvement of omental nodes
Involvement of lymphnodes at the celiac axis
Lymphnode at poa hepatis
Krukenberg tumour