Surgical Treatment of Acute-Bleeding Cancer with Localization in the Body of Stomach

P.V. Ivanchov

Abstract


The statement, that the complication of the tumor with bleeding is the sign of neglect and inoperability, recently experienced a revision. Methods of complex diagnosis of the tumor process and its localization considering the refined intraoperational data, allow to perform radical operations with success to the majority of patients. Progress in this direction is in the early diagnostics, successful conduction of the endoscopic hemostasis, specification of the stage of tumor process and its localization, performance of radical operations after complex preparing and examination with a great number of patients.
The aim of our work is to improve the results of surgical treatment of acute-bleeding cancer with localization in the body of stomach.
In clinics during the period from 1995 to 2012 288 patients with acute-bleeding cancer of the body of stomach received treatment, which was 2.2 % of all the patients, who were treated for gastrointestinal bleedings during the time of work of the centre. The age of 201 (69.8 %) men and 87 (30.2 %) women of this group was from 21 to 93 years. The I stage of the disease was identified in 12 (4.2 %) patients, II — in 56 (19.4 %), III — in 103 (35.8 %), IV — in 117 (40.6 %).
Developed treatment regimen is based on complex conduction of minimally invasive methods of endosurgical hemostasis to stop the active tumor bleeding or its relapse and to prevent the development of relapse of bleeding after its spontaneous stop if there’s unstable hemostasis. Generally endoscopic hemostasis was performed to 113 (39.2 %) patients with the signs of active bleeding, including relapsing, and unstable hemostasis after the spontaneous stop of tumourous bleeding with a high risk of development of the relapse of bleeding. According to specified criteria of indication, operative treatment was performed to 134 (46.5 %) patients: radical operations — to 94 (70.1 %), palliative and symptomatic — to 40 (29.9 %).
12 (9.0 %) patients were operated urgently, 11 (91.7 %) of them were operated radically, 1 (8.3 %) — nonradically. 3 (25,0 %) patients died: 2 (18.2 %) — after radical operations, 1 (100 %) — after nonradical.
122 (91.0 %) patients had operative treatment at the earlier delayed period, 83 (68.0 %) patients were treated radically, 39 (32.0 %) — nonradically. 7 (5.7 %) patients died: 1 (1.2 %) — after radical operations, 6 (15.4 %) — after nonradical operations.
Lymphdissection at the volume D1 was executed when performing 38 (40.4 %) radical operations, and D2 — 56 (59.6 %). After the comparison of frequency of performing lymphdissection at the volume D2, it was determined that when performing urgent radical operations it was executed in 2 (18.2 %) cases of 11, and when performing radical operations at the early delayed period, frequency of its performing is 3.6 times higer and it’s 54 (65.1 %) cases of 83.
General postoperational lethality was 7.5 % (10 patients), specific weight of lethality after nonradical operative interventions is 5.5 times higher comparing to the rate of lethality after radical operations, and lethality after urgent operations is 4.4 times higher than after operative interventions performed at the early delayed period. It was set up that lethality after urgent operations is 15.2 times higher after radical operations and 6.5 times — after palliative and symptomatic operations, comparing to operations, that were performed at the early delayed period.
So we consider that the operations at the level of bleeding in patients with acute-bleeding cancer of the body of stomach are too dangerous, which is related to the high postoperational lethality, so it’s reasonable to perform endosurgical hemostasis and the next performing of operative treatment at the early delayed period, which will provide the increase of the specific weight of radical operations with lymphdissection at the volume D2.


Keywords


cancer of the body of stomach; gastrointestinal bleedings; endoscopic hemostasis; methods of operations

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DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87502

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