Surgery for patients with gastric cancer in the terminal stage of the illness - TNM stage IV.

PURPOSE: To assess any survival advantage in patients with incurable gastric cancer who had undergone resection, bypass or exploratory surgery. In nonresectable patients with pain, the effect of celiac plexus neurolysis was assessed. METHODS: We retrospectively analysed data of 330 patients, operated between 1992 and 2006. The patients were followed until death or last examination. Incurable gastric cancer was defined as TNM stage IV disease: locally advanced (LA), with solitary distant metastasis (SM) or with multiple metastases and/or peritoneal carcinomatosis (MMC). The patients were divided into these 3 groups. Their postoperative survival was calculated and compared in relation to the surgical technique used. Factors which influenced mortality and survival were identified. RESULTS: 131 patients (39.7%) had locally LA cancer, 98 (29.7%) SM, and 101 (30.6%) belonged to the MMC group. The surgical procedures included 138 (41.8%) exploratory laparotomies, 84 (25.5%) bypass procedures and 108 (32.7%) resections. Thirty-three (10%) unresectable patients with pain underwent celiac plexus neurolysis. The mean survival was 21.8 months after resections, 7 months after by-passes and 4.8 after exploratory laparotomies (p = 0.0001). It was 14.57 months (p=0.001) in the LA group, 12.53 (p = 0.005) in the SM group, and 5.2 in the MMC group. Survival was shorter in patients with preoperative weight loss of more than 20 kg (3.2 months, p <0.0001). Postoperative 30-day mortality was 23.2% after exploratory laparotomies, 23.8% after bypasses and 20.4% after resections. Increased mortality was observed in the MMC group (27.7%) and in multivisceral resections (41%, p > 0.05), while significantly increased mortality occurred in patients with weight loss of over 20 kg (32%, p=0.03). Celiac plexus neurolysis was immediately effective in 30 out of 33 (91%) patients (p=0.0001), while 3 months later it was still effective in 15 (45.5%) patients (p=0.08). CONCLUSION: Resections are suggested in the LA and SM groups, and neurolysis in all nonresected patients with pain.

Diagnostic and therapy of locally advanced rectal cancer.

The aim of the study was to check the results of the protocol with neoadjuvant chemoirradiation for the treatment of locally advanced rectal cancer. The value of preoperative methods for staging of rectal cancer was also studied. In the period 1st of June 2000 - 31st of December 2005, 116 patients were included into the study, all with histologically proven rectal cancer up to 12 cm from anal verge and all with T3/T4 No-2 M0 stage. Median follow up was 48 months. Operability rate was 90,1%, local recurrency 12%, and survival 78%, though only 66% without sign of local or distant recurrency.