Anny Xiao Week 3 General Surgery Day 3

This morning we attended the surgery morning meeting (like surgery ground rounds)), which consisted of a presentation on gastric cancer and its prevalence, diagnosis, grading and treatment, followed by a discussion amongst the surgeons & residents. It was coincidentally very relevant to the partial gastrectomy surgery we saw the yesterday so it was fortunate that we caught this presentation. I learned that laparoscopic surgeries and traditional open surgery have similar morbidity and mortality outcomes but laparoscopic surgeries have a shorter time to initiation of an oral diet and earlier discharge from the hospital. Additionally, chemotherapy for gastric cancer actually provides little benefit, although of the chemotherapeutic agents herceptin has been shown to promote a better survival rate and overall response rate.

After the meeting, we went to the outpatient department to see Dr. Ou's outpatients. He had many patients scheduled and spent a total of over 5 hours in the outpatient department today. Many were past surgical patients of his that came for routine follow-up appointments. The first patient was a 64yo female patient with a PMH of breast carcinoma S/P right modified radical mastectomy (MRM) 5 years ago. Dr. Ou explained that a MRM is removal of the breast & subcutaneous tissue with removal of most of the axillary lymph nodes, but it tries to preserve healthy tissue and skin by modifiying the pectoralis major muscle to keep it intact. After the MRM, the patient elected to receive herceptin chemotherapy although the surgery was successful. She spent $70-80,000 NT (~$2300-2600 USD) to receive this elective treatment because she wanted to do everything possible to prevent a recurrence. I think that if targeted chemotherapy treatment cost that much in the US, many more patients would be able to afford their cancer treatment. The patient had just completed 5 years of chemotherapy and recent labs and imaging studies were normal so Dr. Ou scheduled her for removal of her Port-A catheter and instructed her to return for a follow-up visit in 6 months. Interestingly, patients with straightforward cancer cases are managed by the surgeons, who see many patients for follow-up after surgical treatment of cancer. Dr. Ou explained that the more complicated cancer cases are handled by the hospital's hematologist/oncologist (there's only 1 in this hospital), while the surgeons handle the simpler cases.

Another interesting patient had a large thyroid goiter of his right thyroid gland that was surgically removed recently for cosmetic purposes. However, Dr. Ou discovered in the pathology report today that the mass was actually follicular carcinoma, which was surprising since the previous diagnosis in the patient's chart was "nontoxic nodular goiter". The patient explained that this type of cancer is not seen on fine needle aspirations of the thyroid, since the cells appear benign. However, this cancer is invasive and can metastasize. Dr. Ou then ordered a liver ultrasound and other imaging studies to check for metastases, informing the patient that one option is to remove his left thyroid gland as well although it would require a lifetime of thyroid hormone replacement medication. However, if they chose not to remove it, there would be a risk of follicular cancer cell growth in the left thyroid gland, so Dr. Ou assured the patient that he would consult the rest of the surgical team and give him time to think it over in order to find a balance between the quality of life and long-term outcomes for the patient.