Full gastrectomy deemed unavoidable, carried out with robotic system

Doctors say overall health, not age alone, should guide treatment decisions

Kim So-jung, a gastrointestinal surgery professor at the Catholic University of Korea Seoul St. Mary's Hospital Gastric Cancer Center, holds the hand of the 97-year-old stomach cancer patient. [Seoul St. Mary's Hospital]
Kim So-jung, a gastrointestinal surgery professor at the Catholic University of Korea Seoul St. Mary's Hospital Gastric Cancer Center, holds the hand of the 97-year-old stomach cancer patient. [Seoul St. Mary's Hospital]

Seoul St. Mary's Hospital has performed a robot-assisted total gastrectomy on a 97-year-old stomach cancer patient. The medical team said that when deciding whether to operate on elderly cancer patients, doctors should assess overall health — including physical and cognitive function and underlying conditions — rather than age alone.

According to the Catholic University of Korea Seoul St. Mary's Hospital, Kim So-jung, a gastrointestinal surgery professor at the hospital's Gastric Cancer Center, recently performed the robot-assisted total gastrectomy on a patient identified as Y, born in 1929.

About 10 years ago, Y was diagnosed with early-stage stomach cancer in the lower part of the stomach and underwent two endoscopic resections, followed by regular follow-up examinations. This year, a new tumor was discovered near the upper stomach, close to the esophagus.

Although the cancer was at stage one, the tumor was large and had poorly defined margins, making endoscopic resection difficult. Because Y had undergone multiple endoscopic procedures on the lower stomach in the past, preserving even part of the organ was not feasible, and a full gastrectomy became necessary.

Detailed examinations found no evidence that the cancer had spread to other organs. Y was also in good physical and cognitive condition — able to get around without a cane or hearing aid — and the medical team determined that surgery was viable.

When the team decided to proceed with the operation last month, they chose robotic surgery given the patient's advanced age. They judged that the robotic system would allow for precise maneuvering in narrow, deep areas and help minimize bleeding during the procedure.

Unlike a partial gastrectomy, which leaves part of the stomach intact, a total gastrectomy requires removing the entire organ and reconnecting the esophagus directly to the small intestine. The procedure demands exceptional precision: the esophagus and small intestine differ in position, size and tissue characteristics, and any leakage or narrowing at the connection site can lead to serious complications. Post-operative management of food intake, weight loss and nutritional deficiency is also critical.

Y, a former educator, had maintained a regular routine of walking and strength training. At the first outpatient visit after being discharged Tuesday, Y told the medical team and family, "I feel like I am a very fortunate person," expressing gratitude to both.

Kim said age alone should never be the deciding factor in cancer treatment for elderly patients. She said doctors must conduct a comprehensive assessment that takes into account the patient's baseline health, physical function, underlying conditions, cognitive ability and prospects for post-operative recovery.

"For elderly patients, post-operative care is just as important as the surgery itself," Kim said. "There needs to be a careful process of monitoring nutrition, exercise, management of underlying conditions and prevention of complications to help patients return stably to their daily lives."

Kim said she witnessed a family member's cancer battle as a caregiver during her years in medical school. "When treating patients, I try to look not only at the disease but also at what the patient and their family are going through emotionally during the course of treatment," she said, adding that treating patients like family — to ease the anxiety of both patients and caregivers — is an essential part of care.

Meanwhile, Seoul St. Mary's Hospital reached the milestone of 20,000 robotic surgeries last May, about four years after setting a domestic record for the shortest time to reach 10,000 procedures in 2022. Of the 20,000 total cases, roughly 20 percent — 3,798 procedures — were performed using single-port robotic surgery, which requires only one incision.


woo@heraldcorp.com