1Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejing, China; 2Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejing, China; 3Department of Chemotherapy and Chemotherapy, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejing, China
Abstract： Objective Discuss surgical intervention (timing and option) and the effects of maintenance therapy with low dose chemotherapy and nutritional support in patients with advanced gastric cancer by observing 3 cases from the first affiliated hospital of wenzhou medical university. Methods 3 patients with advanced gastric cancer were treated by surgical intervention, low dose chemotherapy and nutritional therapy at different stages as maintenance therapy. Maintenance treatment of chemotherapeutic drugs lasted for 14 days, 7 days interval, 21 days for a cycle, with the 50%~75% dose of the average; the dose was adjusted in next cycle (the adjusted range ± 25%) according to the VAS score (visual analogue scale) of gastrointestinal reaction in the previous cycle and the degree of myelosuppression (blood routine test) and organ injuries; the nutrition program was adjusted (mainly enteral nutrition, supplementally parenteral nutrition) according to the VAS score of enteral nutrition tolerance in the previous day. Results 3 patients lived for 30 months, 15 months, and 22 months respectively; 3 patients had a good compliance to chemotherapy and nutritional treatment (VAS score of 7 points or more, total score of 10 points) and all performed surgery with different purposes. The first patient performed gastrointestinal short circuit operation on the early stage because of gastric intestinal obstruction, and survived total 30 months; the second patient, total survival of 15 months and the postoperative survival 12 months, performed the Palliative total gastrectomy, Roux-Y operation when imaging and anal examination showed primary lesions and pelvic metastases were regression after a period of chemotherapy; the third patient, total survival of 22 months and postoperative survival of 4 months, performed the operation of palliative total gastrectomy and esophageal jejunal Roux-Y anastomosis, total colectomy and ileostomy for malignant obstruction in the late stage for the purpose of reducing the tumor and disengage obstruction. Conclusions Low dose chemotherapy and nutritional support, with the plan adjusted according to the condition changes, can play a certain role in prolonging the survival time and improving the life quality of the advanced gastric cancer patients; the appropriate timing of operation and operative methods have certain effect to prolong the survival time of the patients, but the excessive surgery is not always able to achieve the desired objective, and maybe bring adverse effects due to surgical trauma.
