Question:medium
A 60-year-old male patient has antral carcinoma which is spreading to the head of the pancreas and multiple small metastases to the right lobe of the liver. What will be the best treatment?
A 60-year-old male patient has antral carcinoma which is spreading to the head of the pancreas and multiple small metastases to the right lobe of the liver. What will be the best treatment?
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With distant metastases, curative resection is impossible; focus on palliative bypass of the obstructed gastric outlet.
Updated On: Jun 23, 2026
- Whipple's surgery
- Gastrectomy + Right lobectomy
- Gastrojejunostomy
- Palliative care
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The Correct Option is C
Solution and Explanation
Antral (gastric antrum) carcinoma spreading to the head of pancreas with multiple hepatic metastases represents Stage IV (metastatic) gastric cancer. Curative surgery (radical gastrectomy with R0 margins) is contraindicated because: (a) local extension to the pancreatic head makes en-bloc resection morbid, and (b) multiple liver metastases indicate systemic disease beyond surgical cure. Whipple's procedure targets resectable pancreatic/periampullary primaries -- not applicable here. Combined gastrectomy + hepatic lobectomy is unjustified in multifocal metastatic disease. The key problem in antral carcinoma is progressive gastroduodenal obstruction, which occurs in $\sim 15\%$ of advanced cases. Gastrojejunostomy is a palliative bypass -- the stomach is anastomosed to a jejunal loop, bypassing the obstructed gastroduodenal segment -- allowing the patient to eat, maintaining nutrition and quality of life. This is the best surgical palliation when endoscopic stenting fails or is unavailable. Systemic chemotherapy (e.g., FOLFOX, XELOX) is administered concurrently for disease control. \[\boxed{\text{Gastrojejunostomy}}\]
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