Emergency total gastrectomy for massive haemorrhage in a low income country

Abstract

Background: Gastric cancer is the second most common cancer of the gastrointestinal tract behind colorectal cancer in Cameroon. Total gastrectomy which is recommended for proximal gastric cancer is rarely performed and has not been reported in this country.
Aim: To report emergency gastrectomy  for life threatening haemorrhage of proximal gastric tumours.
Methods: The case notes of all the patients who had total gastrectomy in two major hospitals in Cameroon from August 2002 to September 2009 were reviewed.
Results: During the period, 15 patients had total gastrectomy for cancer. Five (5) patients out of these had emergency total gastrectomy for uncontrollable bleeding proximal ulcer cancer. All the cases were males with the mean age of 64.6years.  A total gastrectomy with a D2 lymph node dissection and a Roux-en-Y oesophago-jejunostomy was carried out. A splenectomy was done in cases when the spleen was involved. Histo-pathological report revealed an adenocarcinoma in 4 cases (80%) and a lymphoma in one case (20%). There was no perioperative mortality but there was a minor complication of superficial wound infection in one case. One patient was lost to follow-up. Two (2) patients died at 18 months and 2 years respectively after the surgery while 2 patients are still alive.
Conclusion: Proximal gastric cancer is more common in men in Cameroon. From our results, it is implied that total gastrectomy can be performed in Cameroon with few complications and an acceptable survival rate.

Keywords: Emergency total gastrectomy; Cancer; Bleeding; Oesophago-jejunostomy