Significance of Surgical Intervention and Perioperative Team Treatment as an Integration of Specialized Care for Oncologic Emergencies in Patients with Unresectable Advanced/Recurrent Gastric Cancer

-The Important Role of Palliative Medicine-

Abstract

Surgical intervention for oncologic emergencies in patients with unresectable advanced/recurrent gastric cancer is controversial. Planned and careful surgery for each individual patient with gastric outlet obstruction (GOO) or malignant bowel obstruction (MBO) must be of clinical significance. However, it may be hard for such patients with GOO or MBO to decide to undergo palliative surgery without any hope of cure. Gastrointestinal surgeons must try for safe operations to allow oral intake, as an initial goal, after obtaining sufficient informed consent. In addition, the integrated treatments by several expert teams before and after surgery may be mandatory to obtain successful intervention allowing oral intake and continued further chemotherapy. The integration of expert care strategies with responsibilities, particularly for psychological management, will play a vital role in a high standard of palliative medicine as well as emergency medicine. The Japanese, hopefully, should reach a consensus on the integrated team treatment by experts who will be responsible for their specialized fields. In contrast, the medical staff including surgeons are asked to acquire humanity and the spirit of cooperation to achieve better team treatment for patients.