Dimensions gastrectomy

Pages: 1 2 3 4 5 6

When deciding on the amount of the operation when cancer of the stomach should be taken into account that the spread of cancer occurs mainly in the proximal direction and that the cancer cells are found in the gastric wall proximal borders macroscopically tumor identified 2-3 cm exophytic and 5-7 cm in endophytic tumors. So when exophytic cancer of the stomach should be removed on line, located on 3-4 cm proximal to the tumor, while endophytic - on 8-10 see Because stomach cancer very early and very often forms metastases, which tracks outflow from him lymph, it is always necessary to remove not only the cancerous portion of the stomach, but all corresponding regional lymphatic system. These are bundles of stomach, which are located in the lymph nodes, the greater omentum. The spread of cancer in the distal direction occurs in much smaller sizes. Here the cancer cells outside the tumor is found less frequently and on a much smaller distance.
The spread of tumors of the output of the division for the gatekeeper, the duodenum, usually occurs only at very extensive damage when not only captured on a large area of the gastric wall, but also blocked the main road lymph drainage.
Thus, the operation when cancer of the stomach should be extensive. Her character is defined by a lesion localization. When a tumor is in the output Department, and exophytic cancer and in areas of the body most surgeons believe shown Subtotal distal resection; localization in the upper third - proximal resection, if the extent of the defeat these operations impossible, produce the complete removal of the stomach.
Currently, the basic rules of surgical treatment of stomach cancer firmly established, and techniques that can be used for operations developed in detail and so simplified that it was to be many practical surgeons. In recent years, results of operations is much improved. If in the pre-war and early post-war years direct mortality after the usual distal resection for cancer reached 30-40% [Bruskin Ya M, 1938 - 42.5 per cent; Bocharov A. A., 1942 - 32,4%; A. Melnikov Century, 1945 - 28,5%], now it went down to 3-7% [Zakharov, N., Zamochiv D. Century, 1971; Svinkin I. K., 1972; Kunitsyn T. A. and others, 1972; Medvedev Century N., 1974, and others]. Complete removal of the stomach, which had previously been known only to the individual leading specialists gastric surgery, is now available to everyone Mature surgeon involved in the treatment of diseases of the stomach. Direct mortality after this operation is 10-15%.
Improved during this period of time and remote results of surgical treatment. If earlier five-year survival after resection of cancer of the stomach was observed only in 15 - 20% undergoing surgery, but now, according to statistics, over 5 years after this operation lives 30-40% and even more. And after total removal of the stomach about exophytic cancer, reportedly more than 5 years lives of 12% and more. Thus, in the surgical treatment of cancer of the stomach should be noted significant progress.
Despite this, the total of the results of treatment of stomach cancer to date, very little has changed. This is due to the fact that patients are hospitalized in such condition that surgical treatment can be applied only in a negligible number. And this number during the last years has changed very little. It can be seen from the following figures. According to A. C. Melnikova (1945), of the 1,400 gastric cancer patients attending health institution, was operated only 12,8%, according to the data of the research Institute of Oncology of AMS of the USSR for 1941 - 12,8%, 1946 - 12,5%, 1948 - 16,3% [a holding S. A., 1952] according to Contineu T. A. et al. (1972) - 16.3%, and R. A. Melnikov (1974) - 10-15% of all admissions to hospital. Thus, in this respect, the numbers changed very little.
Therefore, today, 85-90% of patients with gastric cancer fall to the surgeon only when surgical treatment is impossible. Those patients who still manages to perform the operation in most have such a widespread process that they often do not delete the part and the whole stomach and not only the stomach and cancer of the neighbouring organs. For example, Yu. E. the fine arts (1976) from 1805 radical surgery for cancer of the stomach 145 times had the stomach to remove completely and 385 - producing combined operations. In addition, 1323 patients had only trial and palliative operations.