Long Branch Woman Battles Gastric Cancer with Innovative Endoscopic Procedure
Maria Maldonado, 68, of Long Branch, had become familiar with undergoing endoscopies to detect and remove small tumors in her stomach and abdomen.
Under the direction of Steven Gorcey, M.D., a board-certified gastroenterologist and chief of gastrointestinal endoscopy at Monmouth Medical Center, Maria was put under surveillance to monitor her condition. Over the past several years, Dr. Gorcey detected and removed two small tumors endoscopically. When Maria once again began experiencing bloating and abdominal discomfort, she returned to Dr. Gorcey who performed another endoscopy. This time, he noticed a large tumor in her stomach, and testing confirmed it was gastric cancer that required one of two options: surgical removal called a partial gastrectomy that would require a large abdominal incision and removal of half of Maria’s stomach, or endoscopic submucosal dissection (ESD), which both removes the tumor and determines the depth of invasion into the surrounding tissue.
Dr. Gorcey met with Maria and her daughter Iris, also a long-time patient of his, to discuss treatment options.
“Dr. Gorcey told us the newer option is being done frequently outside of the U.S., but not too many doctors are doing it here,” said Iris. “He would need a laparoscopic surgical team to monitor the dissection and that if things go according to plan it would save half of her stomach. My mother decided to go with it.”
In May, Maria underwent the combined endoscopic laparoscopic procedure with Dr. Gorcey and Frank J. Borao, MD, FACS, FASMBS, chief of minimally invasive surgery at Monmouth Medical Center on standby.
“ESD has been performed in Japan for a number of years for early gastric cancers, but the procedure hasn’t become popular in the U.S. because we don’t have as many cases of early gastric cancer,” said Dr. Gorcey.
“By moving the entire lesion in one block – including the inner layer and the layer underneath that – the pathologist can see if the cancer has spread while still leaving the stomach intact. If the lesion has extended to the submucosal layer, we must then send the patient to surgery,” said Dr. Gorcey, who is one of very few endoscopic surgeons in the U.S. with the training necessary to perform this procedure.
During Mrs. Maldonado’s procedure, Dr. Borao monitored the outside of the stomach with cameras called laparoscopes to make sure everything was going smoothly. The procedure as a whole is called laparoscopic-assisted ESD. By combining flexible endosopy with laparoscopic surgery, Drs. Gorcey and Borao can achieve results that neither could on their own.
“The entire surgery was over in about two and a half hours. Luckily, Dr. Borao never needed to do anything more than observe,” recalls Iris.
Afterwards, Maria spent a few hours in recovery before undergoing additional monitoring. She was ultimately sent home the next day and, within a week, had recovered completely.
“I felt very good after the surgery,” says Maria. “I wasn’t nervous at all beforehand thanks to Dr. Gorcey – he explained everything. He’s a good doctor and took great care of me.”