The technique of removing (deleting) stomach

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We will focus only on the transabdominal way, because the description transthoracic methods would require detailed coverage of the many special issues of thoracic surgery that far would go beyond these tasks. And besides, this section is detailed in the book "Cancer of the esophagus" [Rusanov A. A., 1974].
General rules of operation do not differ from those set forth in the description of the stomach resection. In exactly the same way an incision is made in the abdominal wall and careful examination of abdominal organs. In addition, we always find some more moments playing a decisive role here.
We must bear in mind that the tumor growing from the cardia down the small curvature and on the back, and growing small curvature up to the cardia, sometimes very early start to spread through the gastro-pancreatic link along the left gastric vessels, often sprouting in the retroperitoneal fat, and pancreas. This is because such tumors primarily metastasize to lymph nodes along the left gastric artery. At the confluence of metastatic sites with the primary tumor left vessels are completely enclosed in cancer infiltrate. In addition, it is necessary to observe and direct growth into a bunch of the tumor itself. This infiltrated the area ligaments shrinks and pulls the stomach to the posterior abdominal wall, which then quickly involved in cancer infiltrate. Naturally, when left vessels throughout surrounds cancer infiltrate, bandaging them is impossible, and therefore is impossible and removal of the stomach.
The study of the gastro-pancreatic ligaments and left gastric vessels do the following: hold your finger on the part of the lesser curvature in packing bag and groped passing in the stomach and pancreas conjunction left gastric vessels, determine the attitude of the tumor. If you study the basic trunk artery manages to capture him between the ends of two fingers centrally tumor infiltration, ligation of vessels should be considered possible. If cancer infiltrate so applies to vessels that between celiac artery at the site of discharge from her left gastric artery and cancer infiltrate has no place in order to capture the artery two fingers, the dressing should be considered impossible.
When you have found out the opportunity to tie the left vessels, moving your finger across the back wall of the stomach up, determine the attitude of the tumor to the posterior abdominal wall. Obstacle to highlight the tumor in this area should be considered its immobility, pointing to the germination of muscles. If the tumor is mobile, it grows only in fiber always easy and can be selected by blunt. If the germination is celebrated in the lower divisions, the tumor infiltration very often spreads to the pancreas and deleting it can only be done with a portion of cancer that is hardly appropriate. Remember that even with extensive germination pancreas tumor may be very mobile. The exact ratio between the tumor and the pancreas is usually possible to install only disclosed the packing bag from the greater curvature of the stomach.
Tumor invasion or the presence of metastases in the gate of the spleen and pancreas tail should not be a reason for refusal of operations, as the tumor may be removed with these entities.
Spleen has to be removed not because it can be a place of development of metastases, but because metastases are often formed in the course of the splenic artery and its branches. Oncogene, requiring the removal of the entire stomach, it is approximately 40-70% [Saenko C. F., 1972; birch Yu. E., Shalimov A. A., 1976; McNeer G., 1967, and others].