After surgery for gastric cancer, the patient experienced four episodes of major bleeding and remained in the hospital for a full four months.
Postoperative pathology confirmed local invasion, a finding that could have been identified before surgery.
Preoperative CT showed thickening of the gastric wall on the lesser curvature, suggesting possible local invasion. Additional assessment tools beyond CT should therefore have been used, such as endoscopic ultrasound (EUS). CT has limited ability to resolve the different layers of the gastric wall, whereas EUS can more accurately determine tumor invasion depth (T staging) and the status of surrounding lymph nodes. Laparoscopic exploration could also have been performed to guide a more cautious surgical plan. Postoperative pathology confirmed perineural invasion and infiltration into surrounding adipose tissue, demonstrating that preoperative imaging assessment was insufficient. This has at least two implications: First, the patient might have needed neoadjuvant therapy first. This may explain why some are reluctant to perform thorough preoperative imaging—once the pathway shifts to neoadjuvant treatment, the single surgery revenue stream is affected. Second, clearly defining the relationship between the lesion and surrounding tissues and vessels helps prevent the subsequent episodes of major bleeding. For the patient, the value of this is self-evident.
If the patient had contacted this website at the same time as seeking medical care, more preoperative examinations would have been arranged, revealing the inappropriateness of proceeding directly to surgery. Without surgery, the four episodes of major bleeding would not have occurred.