Successful Recovery: A 71-Year-Old Man Overcomes Gastric Cancer with Surgical Intervention

Case Summary: A 71-year-old male patient visited our hospital due to persistent upper abdominal discomfort lasting 20 days. With a complex medical history including stage 6 chronic kidney disease for 5 years, 20 years of diabetes, and 7 years of hypertension, the patient faced significant surgical risks. However, following a collaborative decision between the medical team and the patient's family, he underwent a laparoscopic total gastrectomy and esophagojejunostomy (Roux-en-Y anastomosis). The surgery was successful, and the patient demonstrated a positive recovery with no major complications.

Patient Profile:
- Age: 71
- Gender: Male
- Condition: Gastric tumor
- Hospital: The Second People's Hospital of Hefei City
- Treatment Date: August 2021
- Treatment Method: Laparoscopic total gastrectomy and Roux-en-Y anastomosis
- Hospitalization: 14 days, followed by outpatient follow-up
- Outcome: Successful surgery with stable creatinine levels and no severe complications

Initial Diagnosis and Assessment
The patient presented with a 20-day history of dull upper abdominal pain, more pronounced at night, which did not subside after eating. He also reported three episodes of melena within the past month. There were no symptoms of nausea, vomiting, acid reflux, or heartburn. An abdominal CT scan conducted at another hospital revealed localized thickening at the gastroesophageal junction. Further investigation, including ECG and gastroscopy, confirmed the presence of a large, irregular ulcerative lesion involving the cardia, fundus, and extending into the gastric body. Biopsy results confirmed gastric adenocarcinoma.

Medical Challenges and Surgical Decision
The patient's multiple comorbidities posed significant challenges. His fasting blood glucose was carefully controlled to around 9–10 mmol/L, and his blood pressure remained stable. Cardiac and pulmonary assessments were completed, and baseline creatinine levels were measured at 370 μmol/L. Given his renal impairment, chemotherapy was contraindicated, and surgery was determined to be the most viable treatment option. After thorough discussion with the family, they agreed to proceed with the operation.

The laparoscopic exploration revealed a localized tumor without distant metastasis. A successful laparoscopic total gastrectomy was performed, along with lymph node dissection and Roux-en-Y anastomosis. The procedure lasted 170 minutes, with minimal blood loss and no need for transfusion.

Postoperative Recovery and Follow-Up
The patient's creatinine levels remained stable throughout the perioperative period. He passed gas on postoperative day 3 and began consuming a residue-free liquid diet on day 7. The abdominal drainage tube was removed on day 11, and he was discharged with good general condition. No adjuvant chemotherapy was recommended by the oncology team, and the patient continues regular outpatient follow-ups.

Key Recommendations for Long-Term Care
Given the complete removal of the stomach, nutritional management is critical. Patients should adopt a strategy of eating small, frequent meals to ensure adequate nutrient intake. Maintaining stable blood sugar and blood pressure levels is essential, as is minimizing antibiotic use and fluid overload post-surgery. Additionally, sufficient rest, a positive mindset, and routine medical check-ups are strongly advised to monitor for any signs of recurrence.

Final Thoughts and Medical Insight
Treating elderly patients with multiple chronic conditions requires a multidisciplinary approach and strong cooperation between doctors, patients, and families. This case highlights the importance of timely surgical intervention, comprehensive preoperative evaluation, and meticulous postoperative care. Despite a delayed diagnosis, the patient's positive outlook and family support played a crucial role in his successful recovery. Regular follow-up visits, along with lifestyle adjustments, will be key in preventing future complications.