[Functional results of digestive tract reconstruction after gastrectomy]. / Funktsional'nye rezul'taty rekonstruktsii pishchevaritel'nogo trakta posle gastréktomii (s kommentariem).

AIM: To substantiate and to prove the advantages of the new method of gastroplasty in comparison with traditional loop reconstruction of digestive tract after gastrectomy. MATERIAL AND METHODS: It was performed prospective comparative study of surgical treatment of 431 patients with gastric cancer who underwent gastrectomy with different variants of digestive tract reconstruction. The main group (146 patients) consisted of patients in whom original technique including establishment of food reservoir in initial jejunal part during reconstruction was applied. The control group consisted of patients with traditional loop reconstruction of the digestive tract (285 patients). RESULTS: Early dumping syndrome (within 1 year) was diagnosed in 9 (13.2%) patients of the main group and 16 (21.6%) patients of the control group. Mild and moderate degrees of this syndrome were observed in 7 (77.8%) and 10 (62.5%), 2 (22.2%) and 4 (25.0%) patients in the main and control groups respectively. Severe dumping syndrome occurred in 2 (12.5%) patients only in the control group. Late dumping syndrome was revealed in 7 (10.3%) and 11 (14.9%) patients, respectively. Body mass index was 18.7±0.8 and 17.4±0.6 (p<0.05), respectively. After 2 years early dumping syndrome was diagnosed in 6 (14.3%) and 10 (21.3%) patients, mild degree in 5 (83.3%) and 5 (50.0%) patients; moderate degree in 1 (16.7%) and 3 (30.0%). Severe dumping syndrome was confirmed in 2 (20.0%) patients from the control group. Late dumping syndrome occurred in 4 (9.5%) and 7 (14.9%), respectively. Body mass index was 21.2±0.7 and 19.0±0.9 (p<0.05), respectively. After 3 years, early dumping syndrome in mild form was diagnosed in 2 (10.5%) cases and late syndromy in 1 (5.3%) patient of the main group. There were 5 (21.7%) patients with the syndrome in the control group including mild and moderate severity in 3 (60.0%) and 2 (40.0%) patients respectively. Late dumping syndrome occurred in 3 (13.0%) patients. Body mass index was 21.9±1.0 and 19.7±0.6 respectively. CONCLUSION: Food reservoir in the initial part of jejunum after gastrectomy creates better conditions for the normalization of metabolic exchange resulting early functional digestive adaptation, especially in long-term period.

[Prevention of reflux-esophagitis after gastrectomy].

It is presented the results of gastrectomy in 431 patients with varying reconstructive-reparative stage. Patients were divided into two comparable groups. The main group consisted of 146 patients who underwent developed technique with food reservoir performing after gastrectomy. Control group included 285 patients after conventional digestive tract reconstruction. It was concluded that 30.4% of patients have entero-esophageal reflux, in 21.7% and 8.7% of patients endoscopic and morphological signs of reflux-esophagitis were observed respectively. Suggested technique creates gas bubble providing obturator mechanism and decreasing the frequency of entero-esophageal reflux to 26.3% and reflux-esophagitis to 5.3%. It proves advantage of suggested method of gastroplasty for prevention of reflux-esophagitis in comparison with traditional digestive tract reconstruction after gastrectomy.

[Spleen-preserving D2 lymphodissection in gastrectomy]. / Splenosokhrannaya limfodissektsiya D2 pri gastrektomii.

AIM: To analyze immediate and remote results of surgical treatment of 480 patients with gastric cancer who underwent total gastrectomy. MATERIAL AND METHODS: The study group included 371 patients who had spleen-preserving D2 lymphodissection during gastrectomy and control group consisted of 109 patients after D2 lymphodissection with splenectomy. Duration of surgery was 183.7±33.8 and 184.1±30.9 min in study and control groups respectively (p=0.72), blood loss - 330.2±33.7 and 351.8±28.8 ml (p=0.0001), incidence of postoperative complications - 6.7% (25 cases) and 4.6% (5 cases) respectively (p=0.5), mortality rate - 2.7% and 0.9% respectively (p=0.46). Number of excised regional lymph nodes of groups 10 and 11 was in most patients of the study group - 5.8 and 5.5 (p=0.92). Metastases in splenic hilus lymph nodes were diagnosed in 28 (7.5%) and 9 (8.2%) patients of the study and control groups respectively (p=0.30), metastases in lymph nodes along splenic vessels - in 24 (6.5%) and 7 (6.4%) patients respectively (p=0.90). RESULTS: 5-year survival in the study group was 40.3±3.0%, average life expectancy - 3.4±3.3 years, in the control groups - 33.1±5.6% and 2.7±2.5 years respectively. It was concluded that spleen-preserving D2 lymphodissection decreases incidence of postoperative complications and has similar drastic nature as standard lymphodissection with splenectomy.

[Survival rate after D3-lymphadenectomy for right-sided colic cancer: case-match study].

UNLABELLED: The aim of the study was to compare the effectiveness of D3-lymphadenectomy in compliance with «no-touch¼ principle and mesocolectomy with traditional hemicolectomy in patients with right-sided colon cancer. MATERIAL AND METHODS: It is retrospective-prospective comparative case-match study. From prospectively collected database patients with right-sided colon cancer stage I-III treated in 2009-2013 without adjuvant chemotherapy were selected. Patients who underwent conventional right-sided hemicolectomy with D2-lymphadenectomy in the regional oncologic dispensary formed the first group. The second group included patients after right-sided hemicolectomy with D3-lymphadenectomy, «no-touch¼ principle and mesocolectomy performed in academic hospital of the third level. From both groups 'case-match' patients by gender, age, stage and location of primary tumor were selected. Each group consisted of 50 patients. RESULTS: Overall and cancer-related 5-year survival was significantly higher in the second group - 80.9% vs. 56.0% (p=0.01) and 93.4% vs. 59.8% (p=0.01), respectively. CONCLUSION: D3-lymphadenectomy and mesocolectomy for right-sided colon cancer stage I-III without adjuvant chemotherapy provides significantly better overall and cancer-related 5-year survival compared with conventional right-sided hemicolectomy. Thus, D3-lymphadenectomy and mesocolectomy in compliance with «no-touch¼ principle for right-sided colon cancer is reproducible and effective in Russian conditions.

[Reconstruction after the gastrectomy by proximal stomach cancer].

The 30 years experience of surgical treatment of the proximal gastric cancer type II and III by Siewert classification in 681 patients was analyzed. 448 gastrectomies and 233 gastrectomies with proximal esophagus resection were performed. Gastrectomy with esophagus resection led to more complications (34.8±3.1%; p<0.001) and lethal out±comes (21.5±2.7%), then standart gastrectomy (16.5±1.8% and 7.6±1.3%). The dehiscence of the esophagointestinal anastomosis was registered in 5.6±1.6% after the gastrectomy with esophagus resection and in 0.2±0.2% after the transperitoneal gastrectomy (p<0.001). The loop method by Schlattler proved to be the optimal reconstructive technique. The Roux-en-Y anastomosis was preferable by the insufficient length of the mesentery. The risk factors of the esophagointestinal anastomosis insufficiency were: cancer stage (p<0.001), local invasion of the neighbouring organs (p<0.05), combined surgery and esophagus invasion (p<0.001), male gender (p<0.001) and lack of the surgical skills for gastrectomy (p<0.02).

[Reintervention for cancer of operated stomach]. / Povtornye vmeshate'stva po povodu raka rezetsirovannogo zheludka.

From 1958 to 2000 yrs in 405 patients were performed reoperations for the resected stomach cancer, of them 209 (51.6%)--gastric reresection. Combined intervention was done in 65.6% of observations. Mortality was 20.6%, in the last consecutive 93 patients--10.7%. Three-year survival index was 40.9%, five-year one--26.2%, ten-year--22.3%. Late follow-up results did not differ from such after the first operation for gastric cancer because together with gastric remnant were excised intestinal loop, incorporated in anastomosis with her mesentery, in the lymph nodes of which the tumor metastasizing occurs along the lymphatic ways newly created after gastric resection conduction.

[Routes of lymph outflow from the operated stomach]. / Puti ottoka limfy iz operirovannogo zheludka.

The pathways of lymph discharge from the stomach at different stages after resection and gastroenterostomy were studied by filling the lymphatics with 50% Indian ink. The study used 55 noninbred dogs and 12 preparations of human resected material obtained in repeated surgery. It was found that lymph is discharged through intact lymphatic via within 40 days after subtotal resection and 10 weeks after partial resection and gastroenterostomy. At later stages lymph is discharged via newly developed vessels which extend from the stomach across anastomosis axis onto intestinal wall and further on to the lymph nodes of its mesentery. At month 3 after subtotal resection and month 5 after partial resection and gastroenterostomy, the lumen diameter of such lymphatics matched that of intact lymphatics of the stomach. Postoperative formation of lymph discharge via suggests that cancer may be directly disseminated from the operated stomach into the mesenteric lymph nodes.

[Substantiation of the extent of radical operations in cancer of the gastric stump]. / Obosnovanie ob'ema radikal'nykh operatsii pri rake kul'ty zheludka.

The author shows that a characteristic feature of metastazing carcinoma of the gastric stump is frequent lesions of the mesenterial lymph vessels. The isolated lesion of this group of lymph vessels is also shown to be possible. A conclusion is made about the absence of the "intestinal barrier" and a necessary removal of the intestine loop and its mesenterium involved in anastomosis when performing radical operations for carcinoma of the gastric stump.