[Causes of nonradical surgical operations for cancer of the proximal part of the stomach].

An analysis of results of treatment of 454 patients operated for cancer of the proximal part of the stomach included the main parameters of the tumor process and radical operations studied on the basis of morphological investigations of the ablated preparations. The vertical and horizontal lines of the gastric resection were thoroughly investigated, the results being introduced in the protocol of the investigation. In 49 of 454 radically operated patients (10.7%) the line of resection passed through the zone of tumor infiltration. It was shown that the frequency of the tumor cells left along the resection line was substantially influenced not only by the growth character, the histological structure of the tumor and involvement of the esophagus, but also by the kind of operative access and surgery. We believe that in patients with poorly differentiated carcinomas (G3-G4) and endophylic-infiltrative forms of tumor growth it is necessary to principally widen the resection zones both in the vertical and lateral directions. It will allow avoidance of making the line of resection in the tumor infiltration zone. Not only the gastric resection zones but also all anatomical structures adjacent to the tumor ablated during the combined surgical operations should be thoroughly morphologically examined. The intraoperative urgent histological investigation of the gastric resection line must be made in all radical operations for gastric cancer.

[Evaluation of surgical traumaticity of standard and extended surgical procedures in cancer of a proximal part of the stomach].

Analysis of the results and evaluation of surgical trauma of 454 various resections for cancer of a proximal part of the stomach were carried out. Proximal subtotal resection of the stomach with resection of the esophagus were performed in 151 patients (33.2% of all the resections). Gastrectomy was performed in 296 (65.2%) patients. Standard resection was carried out in 254 (55.9%) patients, extended -- in 72 (15.8%), combined -- in 64 (14,1%), extended-combined -- in 64 (14,1%). It is demonstrated that number of complications after surgical treatment of cancer of a proximal part of the stomach is high enough due to traumaticity of abdominal-thoracic surgical procedures. Surgical approach, duration of surgery, intraoperative blood loss have significant influence on short-term results. Duration of surgery more than 300 min is the main factor making worse short-term results of extended resection of the stomach. In such duration of surgery postoperative complications were seen in 45.0+/-11.4%, lethal outcome -- in 30.0+/-10.5% cases. Extended surgical procedures demonstrate better long-term results. Five-years survival of patients with cancer of proximal part of the stomach (stage II and III) after extended surgeries is 53.3+/-13.3 and 33.3+/-6.3%, respectively. Standard resection is recommended for elderly patients with low functional reserves.