Treatment of precancerous diseases

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In the General system of cancer of the stomach is a very big place is occupied treatment of precancerous diseases, among which the surgeon often have to meet with polyps in the stomach and with kaluznij gastric ulcers. We already mentioned a great propensity for malignancy as polyps and chronic gastric ulcers. Prevention of this process are such an important issue that requires special consideration.
Has been established opinion about the need gastrectomy all patients with gastric polyps [Petrov N. N., 1952; A. Melnikov Century, 1954; Popovyan I. M., Koshelev Century. N 1965, and others].
Initially, we strictly adhere to this opinion, producing in each case of polyposis resection of the stomach. Of these patients, we managed to trace the fate of 134 operated since 1952; 5 Of them have developed cancer gastric stump and 4 polyposis, i.e. a total of about 7%. According to the clinic, headed by N. N. Elansky [Shkrob O. S. Nikolaev A. Century, 1965] cancer development in the cult of the stomach, resected for benign polyps, occurred in 8%. Team statistics M. I. talalaeva (1966) from 518 patients who underwent resection of the stomach for benign polyps, 55 (10,8%) subsequently developed polyps or cancer of the stomach stump. About the same results speak and other surgeons.
Therefore, distal resection of the stomach with polyposis does not save the patient from cancer in the remaining part of the stomach. Because recurrence of polyps and their malignant transformation is possible not only in the distal stomach, which can be removed by surgical resection, but equally in the proximal that remains. So if, producing when polyposis resection of the stomach, consider it acceptable to preserve its proximal part, with the same base can be considered valid and the preservation of other departments, producing not resection, and the excision of the polyp together with a small plot surrounding the stomach wall.
It is quite clear that it applies only to such polyps, the purity of which is established by histological examination. Polyps, with signs of malignancy should be considered as cancer and treated according to the rules provided for his treatment. To consider them not as polyps and cancer.
So, in benign polyp the polypectomy can hardly be considered less appropriate operation than distal resection of the stomach. On the contrary, the results polypectomy, according to available reports, appear to be more favorable. HP Rudova (1972), following 105 patients who were polypectomy in the period from 1 to 22 years, only one noted the development of cancer, and 3 - polyp recurrence. Similar data leads Century N. Sagaidak (1961) and the other Of 40 patients who were followed-up by us after polypectomy for 1 to 12 years, none were identified any recurrence of polyps or cancer of the stomach.
In addition, the entire operation polypectomy is much easier and safer gastrectomy. In contrast to the latter it does not lead to any functional impairment. And such a violation after resection of the stomach produced about polyps, patients get used with great difficulty, since before resection many of them did not feel any pain from the side of the stomach.
All this allows to assume that in benign polyp typical gastrectomy is much less useful operation than excision area gastric wall containing a polyp. Last as organ-sparing surgery to relieve a patient from losing stomach, it appears from the point of view of prevention of a cancer is more expedient.