[RESULTS OF GASTROPLASTY, USING ILEOCECAL SEGMENT OF INTESTINE AFTER COMBINED GASTRECTOMY].

Results of treatment of 18 patients for locally spread gastric cancer, in whom after combined gastrectomy gastroplasty was accomplished, using ileocecal intestinal segment (the main group), were presented. In a comparison group 20 patients were included, in whom after combined gastrectomy end-to-loop esophagojejunoanastomosis was formated. Early postoperative complications have occurred in the main group--in 7 (38.8%) patients, and in comparison group--in 6 (30%). Postoperatively 2 (11.1%) and 2 (10%) patients died, accordingly. Gastroplasty, using ileo-cecal intestinal segment, have promoted reduction of the remote postgastrectomy syndromes occurrence rate from 58.8 to 11.1%. In a comparison group median survival was 18.6 mo, and in the main--a survival mediana was not achieved, because the investigation still goes on.

[Stomach carcinoma. Optimizing therapy by stomach replacement or subtotal resection?]. / Magenkarzinom. Optimierung durch Rekonstruktion eines Magenersatzes oder subtotale Resektion?

The extent of surgical resection in the treatment of gastric carcinoma depends on the tumor site as well as on the histomorphological type according to Lauren taking into account the margins of clearance at the oral resection line. Following subtotal distal gastrectomy functional long-term results might be generally better in comparison to total gastrectomy. Among the large variety of operative methods of reconstruction after total gastrectomy the Roux-en-Y procedure is preferred by the majority of surgeons. Nevertheless, according to experimental and clinical trials jejunal interposition technique seems to allow a more physiological gastric replacement with improved postoperative function and quality of life. Furthermore, jejunal interposition can influence the motility of the entire intestinal tract resulting in a better functional outcome. The importance of pouches for gastric substitute with positive impact on the long-term nutritional status must be clarified in further clinical trials. In conclusion, the question of ideal mode of reconstruction of the upper gastrointestinal tract is still open and continues to be found out.

[Quality of life after prograde jejunum interposition with and without pouch. A prospective study of stomach cancer patients on the reservoir as a reconstruction principle after total gastrectomy]. / Lebensqualität nach prograder Jejunuminterposition mit und ohne Pouch. Eine prospektive Studie bei Magencarcinompatienten zur Frage des Reservoirs als Rekonstruktionsprinzip nach totaler Gastrektomie.

Out of 74 consecutive patients with gastric carcinoma only 39 patients fulfilled the inclusion criteria for this randomized study. These patients were divided into two groups intraoperatively, 21 were reconstructed with and 18 without performing a stapled interposed jejunal pouch. Quality of life was evaluated using Spitzer's QL index and Cuschieri's assessment for 6 months. Spitzer's QL index showed--as expected--no differences concerning the specific reconstruction in gastrointestinal complaints, whereas Cuschieri's assessment revealed an advantage in the pouch group. Cuschieri's assessment needs to be validated by larger comparable groups to prove its suitability for the determination of specific gastrointestinal complaints concerning the type of reconstruction in gastric cancer patients.

[Surgical treatment of stomach and duodenal ulcer]. / Operative Behandlung des Ulcus ventriculi und duodeni.

Despite lots of innovation in conservative treatment, surgery has established in ulcer therapy. Elective surgery shows a very low mortality rate whereas that of emergency operations is approximately ten times that high. If one intends to improve the currently insufficient results of ulcer treatment, this is only possible by decreasing the number of emergency operations which for many years remains on a nearly unchanged level, in favour of elective surgery. This especially is true for patients on high risk regarding an ulcer complication. Most important complications are recurrent phases within short time and poor compliance. A further complication is any critical factor in general which leads to the assumption that an appearing ulcer complication may most likely not be survived. Critical factors mainly are advanced age and attendant cases of illness. It may be expected that the still high mortality of this benign disease can be considerably reduced by applying the formula "more elective--less emergency surgery".

[Late results of surgical treatment of cancer of the stomach]. / Otdalennye rezul'taty khirurgicheskogo lecheniia raka zheludka.

Based on an investigation of long-term results of surgical treatment of 230 patients with gastric cancer operated upon in 1972-1981 the authors have found that 5-year survival was substantially worse in groups with the IIIrd stage cancer (in metastasis to regional lymph nodes, in the ingrowth to the serous membrane of the stomach), in nondifferentiated cancer in patients older than 60. Localization of the tumor, character of the operation fulfilled, the availability of gastric history do not influence the survival of the patients. Non-radical operations give worse results. Early diagnostics of gastric cancer is thought to be a way to solve the problem.

Surgical management of malignant tumors of the esophagogastric junction: a retrospective review of 188 patients.

A series of 188 patients with cancer of the esophagogastric junction were operated from 1960 to 1985. Their age range was 18-79 years old and 73% were males. Mean duration of symptomatology was five months and 93% were affected by dysphagia. Surgery was limited to exploratory laparotomy in 17 patients (9%), feeding gastrostomy in 14 (7.5%), Celestin endoluminal tube in 31 (16.5%), jejunal by-pass in one and tumoral resection in 125 (66.5%). The predominant procedures of resection were total (64%) and proximal gastrectomy (28%). To restore digestive continuity, the stomach was used in 40 (32%) cases, jejunum in 67 (53.6%) and colon in 18 (14.4%). Eighty-eight per cent of tumors were adenocarcinomas. Seventeen per cent of patients died in the post-operative period: 18.4% following resection (17.5% following partial gastrectomy and 18.8% following total gastrectomy) and 14% following palliative measures. Five-year survival rates were 11.8% for resected cases, 8.7% for total gastrectomized patients and 18.2% for partial gastrectomized tumors.

[Surgical treatment of patients with bleeding stomach ulcers]. / Khirurgicheskoe lechenie bol'nykh s krovotochashchimi iazvami zheludka.

The results of treatment of 480 patients with bleeding gastric ulcers are presented. The more wide use of the Billroth-I gastric resection (135 patients) versus Billroth-II gastric resection (54 patients) permitted to reduce the incidence of early postoperative complications from 42.6 to 15.6%, and lethality--from 24.1 to 3.7%. The use of therapeutical tactics based on the endoscopic characteristic of a source of bleeding, evaluation of the dynamics of pathological process, severity degree of blood loss with regard for location and size of the ulcers, and with regard as well for the differential approach to the choice of a method of operative intervention permitted to reduce the total lethality from 22.8 to 7.2%, lethality after the emergency operations--from 34.4 to 13.5%, total postoperative lethality--from 23.8 to 9.5%, to increase the specific weight of radical operations from 43.8 to 69.7%, reduce lethality after conservative treatment of the patients from 21.5 to 3.7% when compared with that in active-expectant tactics.

Nutritional effects of postgastrectomy reconstruction: a clinical evaluation.

To evaluate the nutritional benefits of a jejunal pouch vs. esophagojejunostomy following total gastrectomy, we reviewed 24 consecutive cases of total gastrectomy: 14 males and 10 females, 39 to 85 years of age (mean 66.6 y.) undergoing 9 jejunal pouches (JP) and 15 Roux-en-Y esophagojejunostomy (EJ). Indications for surgery included 15 adenocarcinomas, 3 lymphomas, 1 leiomyoma, and 5 hemorrhagic gastritis. The operative mortality was 12.5%. One JP patient was lost to follow-up. The mean survival for EJ was 13.3 months and for JP 36 months. Total gastrectomy resulted in persistent weight loss and hypoalbuminemia, and the creation of a jejunal pouch did not seem to improve significantly the nutritional status following total gastrectomy.

[Technical prerequisites for performing controlled studies with the goal: postoperative quality of life after gastrectomy]. / Technische Voraussetzungen zur Durchführung kontrollierter Studien mit dem Zielkriterium: Postoperative Lebensqualität nach Gastrektomie.

A study of 78 cases of gastrectomy in which two reconstruction procedures Roux-en-Y + pouch and interposition + pouch were compared and which is still in progress, yielded the following results: 1. It is possible to use both methods only with staplers and have few complications in a time-saving procedure. 2. A Roux-en-Y + pouch takes mean = 50 min; an interposition + pouch requires mean = 90 min (net time of reconstruction). 3. It is sometimes impossible for anatomical reasons to use an interposition + pouch. 4. The more complex procedure--the interposition + pouch--does not have a higher rate of complications. 5. Technical development permits controlled studies investigating the long-term target: quality of life.

Mortality caused by stomach cancer after remote partial gastrectomy for benign conditions: 40 years of follow up of an Amsterdam cohort of 2633 postgastrectomy patients.

Mortality caused by stomach cancer was analysed in a cohort of 2633 postgastrectomy patients who underwent surgery for benign conditions in the academic medical centre of the University of Amsterdam between 1931-1960. In comparison with mortality from gastric cancer in the general Dutch population, the observed versus expected ratio in the postgastrectomy group was significantly increased among women, after a postoperative latency of more than 15 years (O/E: 4.77; p = 0.011) and among men after a postoperative latency of more than 25 years (O/E: 3.13; p = 0.005). The analysis confirms that the discrepancies in risk appraisal which seem to exist between reports published in Europe and the USA may be explained by the differences in length of follow up in these studies.

[Surgical experience of cancer of the resected stomach]. / Opyt khirurgicheskogo lecheniia raka rez etsirovannogo zheludka.

The results of surgical treatment of 40 cases of cancer developing in the gastric stump were analysed. 97.5% of patients were operated on; 41% underwent radical surgery and 20.5%--palliative resection. Postoperative mortality in the radical surgery groups was 43.7%, and 50% in the other group. 12.5% of the radically--operated patients survived over 5 years. Moreover, pathogenetic patterns of the disease as well as optimal terms for starting regular postoperative follow-up are discussed.

A new approach for the surgical treatment of late post-total gastrectomy syndromes.

The value of a new reconstructive procedure after total gastrectomy is assessed in 79 patients who underwent this operation between 1964 and 1979. The results obtained in terms of mortality and of early and late morbidity have been most satisfactory. The new method offers to the patient an elimination of his post-total gastrectomy symptoms, a sense of well-being, a satisfactory nutritional status and a potentially reasonable working capacity, without added risk of mortality or morbidity. Postoperative studies are presented which demonstrate that the reservoir created does not dilate but retains active peristalsis and controls emptying time in a nearly normal manner. A hypothesis is put forward to explain this. Thus from the results of this paper it may well be recommended in dealing with patients who are submitted to total gastrectomy.

Partial gastrectomy for peptic ulcer by the Krønlein method. Long term results 12 years later with particular reference to general health condition and working capacity.

A one-year material of 97 patients was studied 12 years after partial gastrectomy for peptic ulcer. These patients had all been subjected to a standard Billroth II type operation as described by Krønlein, with emphasis laid upon a transverse position of the gastrojejunostomy. Of the seventy-six patients who were available for evaluation, 15 patients (20%) had some symptoms. The overall grading of results according to Visick was: I in 80 per cent, II in 9 per cent, IIIs in 7 per cent, IIIu + IV in 4 per cent. Three patients had retired and one had changed work partly because of postoperative symptoms.

[Cancer of the stump of the stomach]. / Rak kul'ti zheludka.

In analysis of the mortality causes in the patients, previously subjected to gastric resection for ulcerous disease, it was found that the specific weight of the tumor of the remaining gastric portion in females was 2 times as much as in males (19.5% and 10.1% according to the autopsy findings, 10.2% and 6.8% as shown by the followup materials). There were revealed a number of factors causing these differences, the principal of them being: 1) predominance of senile subjects among the female group, 2) a later occurrence of gastroduodenal ulcers in them, 3) predominance of gastric ulcers over duodenal ones, 4) a longer survival in gastrectomized patients.

[Immediate and late results of surgical alternatives in the treatment of non-resectable duodenal ulcers (author's transl)]. / Resultados imediatos e tardios de operações em que não resseca a úlcera duodenal (vagotomia e gastrojejunostomia ou antrectomia com exclusão a finsterer), em "duodenos difíceis".

The authors present 69 patients with duodenal ulcer considered as non-resectable ("difficult duodenum"). Troncular vagotomy associated with gastrojejunostomy (VTGE) were performed in 26 cases. This surgical approach was chosen for patients with advanced age, poor general condition and, obesity. When local conditions such as deformity, post-bulbar ulcer and penetrating ulcers were present, troncular vagotomy with antrectomy and Finsterer exclusion (VTAF) was the procedure of choice (43 cases). The incidence of duodenal fistula during the hospital stay was high (6,9%) in the VTAF group but the mortality rate was low, as oposed to the high mortality rate after VTGE. This is in agreement with other authors. Regarding the late results (follow-up for over 1 year in 58.3% of the VTGE group and, 70.5% of the VTAF group) a recurrence rate of 16.6% was observed in the VTGE group and, none in the CTAF group. The authors conclude that in the non-resectable duodenum, the procedure of choice is troncular vagotomy with antrectomy and Finsterer exclusion. Troncular vagotomy and jejunostomy should be considered as an alternative and, performed only in obese patients, over the age of 65 and in poor general condition.

[Analysis of surgical treatment of 592 cases of cancer of the stomach]. / Analisi dei risultati del trattamento chirurgico di 592 casi di cancro dello stomaco

A series of 592 cases of gastric carcinoma operated on between January 1960 and December 1974 at the S. Croce Hospital at Cuneo is reported. The following observations were made: greater frequency in males (68.25%). The following localizations: cardiac portion 31 cases; fundus 20; body 93 and antropyloric 249. Cancer ulcer in 5.06% of cases. Cancer on the gastric stump in ulcer resections in two cases. The following operations were performed: Gastric resection in 325 cases: operative mortality (O.M.) 5%; 5-year survival: 18%. Total gastrectomy in 38 cases: O.M. 13.1%; 2-year survival: 21%, 5-year survival 5.2%. E.A.G. in 61 cases; O.M. 17.8%; survival: 6 months; maximum 26 months. Gastrostomy in 16 cases; Expl. laparotomy in 150 cases. Survival was only a few months in these two latter groups. Out of all operations 5-year survival was 6.7% and 27.4% in so-called curative interventions. In principle, gastric resection is still considered to be the most valid approach.

[Choice of surgical technic in cancer of the stomach. Results in 999 cases]. / Izbor operativne metode kod karcinoma zeluca. Iskustva na 999 slucajeva.

Authors analyze 999 of stomach cancer, as well as 865 operated patients (86,58%). Choice of operative method depends concert tumor localisation, its growth, methastasis, general condition and age of patient.