OPTIMIZATION OF SURGICAL TACTICS FOR TREATING PATIENTS WITH GASTRIC CANCER IN CASE OF VARIANT ANATOMY OF THE CELIAC-MESENTERIC BASIN

2019 ◽  
Vol 65 (4) ◽  
pp. 537-545
Author(s):  
Aleksandr Zakharenko ◽  
Kirill Vovin ◽  
Mikhail Belyaev ◽  
Anton Trushin ◽  
T. Kupenskaya ◽  
...  

Relevance: The variability of the visceral vessels occurs from 10 to 30%. There are anatomical options in which the main arteries of the stomach depart from the aorta or superior mesenteric artery. The recommended standardized surgical technique for radical treatment of gastric cancer is defined for typical vascular anatomy. Objective: To improve the results of surgical treatment of patients with gastric cancer (GC) by optimizing the diagnostic algorithm and correcting surgical techniques. Material and Methods: The results of surgical treatment of 296 patients with gastric cancer cT1-4N1-2M0, who were treated at I.P. Pavlov First St. Petersburg State Medical University from 2012-2017. In the main group of patients (n = 176), the proposed diagnostic and treatment algorithm was applied (spiral computed tomography in the angiographic mode (SCTA) + with the discharge of the vessel participating in the blood supply to the stomach from the aorta (AO) and / or the superior mesenteric artery (SMA) extended lymph node dissection D2 + № 16a2, № 16b1). All patients were radically operated. The evaluation of the diagnostic characteristics of SCTA was performed. The results of treatment were evaluated in 108 patients of the main group. The comparison group (n = 120) consisted of patients in whom vascular anatomy was not studied. Estimated blood loss, time of operation, the frequency of perioperative complications and long-term survival. Results: In 32,9 % (n = 58) patients, variant anatomy of the visceral vessels of the upper abdominal cavity was detected. Additional arteries with typical trifurcation were found in 21,6 % (n = 38) of cases; celiac trunk bifurcation was determined in 10,2 % (n = 18) of patients; the absence of the celiac trunk and a single celiac-mesenteric trunk were found in 1,1 % (n = 2) of patients. The sensitivity of SCTA was 95,7 %, specificity 94,4 %, total accuracy 95,4 %. As a result of the applied diagnostic and treatment algorithm, the standard volume of D2 lymph node dissection was performed in 124 (70,4 %) patients during the surgical treatment of the main group of patients. Expansion of lymphadenectomy to D2 + was required in 52 (29,5 %) patients. Metastases to lymph nodes of groups № 16a2 and № 16b1 in patients who underwent extended D2 + lymph node dissection were detected in 16 (30,8 %) cases. The average blood loss in the main group was 1,95 times less and amounted to 126,5±22 ml, and in the comparison group - 246,7±34 ml (M ± m, p = 0,0276). A comparison of the average duration of the operation did not show any significant differences: in the comparison group it was 188,2 ± 16,4 minutes, while the main group was slightly lower - 172,3 ± 21,5 minutes. In the main group, the total number of complications was 14 cases (13,5 %) and was significantly lower than in the comparison group - 29 cases (25,9 %). Survival for 1-2-3 years in patients of the main group was higher than the comparison group and amounted to 92,6, 75,0, 53,7 % and 90,8, 71,8, 47,5 %, respectively. The relapsefree 1-2-3-year survival of the group of patients to whom the diagnostic and treatment algorithm was applied was also higher than in the comparison group and amounted to 90,7, 73,1, 48,1 % and 90,8, 68, 3, 44,2 %, respectively. The median survival was significantly better in the main group of patients - 31,4 months, in the comparison group - 28,5 months. Conclusions: Performing SCTA at the preoperative stage is an effective way to visualize the great vessels, allowing to plan the volume of the operation, to avoid perioperative complications. Expanding the volume of lymph node dissection to D2 + № 16a2, № 16b1 when the vessel participating in the blood supply to the stomach from the AO and / or SMA is released, as it allows to improve the long-term results of treatment of patients with gastric cancer, by increasing radical surgery.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 4105-4105 ◽  
Author(s):  
Young Woo Kim ◽  
Young-Kyu Park ◽  
Hong Man Yoon ◽  
Byung-Ho Nam ◽  
Keun Won Ryu ◽  
...  

4105 Background: Benefit of quality of life made laparoscopic gastric cancer surgery attractive, but there are still concerns about laparoscopic lymph node dissection. The aim of this study was to evaluate a feasibility of laparoscopy-assisted distal gastrectomy (LADG) with D2 lymph node dissection compared with open distal gastrectomy (ODG) for advanced gastric cancer (AGC). Methods: Patients with cT2-T4a and cN0-2 (AJCC 7th staging system) distal gastric cancer were randomly assigned to LADG or ODG. The primary endpoint was the non-compliance rate of the lymph node dissection defined as rate of cases where there was more than one missing lymph node station according to the guidelines of the Japanese Research Society for Gastric Cancer lymph node grouping. Secondary endpoints were perioperative complications, changes of inflammatory and immunological parameters, postoperative hospital stay, and 3 year disease free survival. This trial was registered at ClinicalTrials.gov as NCT01088204. Results: Between Jun 2010 and Oct 2011,204 patients were randomly allocated and underwent either LADG (n=105) or ODG (n=99). 8 patients were excluded in the intention to treatment analysis because of protocol violation and patient’s withdrawal of permission, and finally 100 patients in LADG and 95 patients in ODG were analyzed. There were no significant differences of overall non-compliance rate of lymph node dissection between LADG and ODG groups; they were respectively 47.0% and 43.2%. (p=0.648). In the subgroup analysis according to the stratified risk groups, non-compliance rate in LADG was significantly higher than ODG (52.0% vs. 25.0%, p=0.043) for clinical stage III but it was not significantly different for stage II (46.2% vs. 48.9%, p=0.788). Intraoperative event rate was not significantly different between groups (LADG;6.0% and ODG;4.2%, p =0.748). Complications rate in early postoperative period up to 1 month was also not different between groups (LADG;17.0 %, ODG;18.8%, p=0.749). Conclusions: LADG was feasible in AGC compared with ODG, especially in clinical stage II in terms of non-compliance rate of D2 lymph node dissection and perioperative complications. Clinical trial information: NCT01088204.


Author(s):  
Van Huong Nguyen

TÓM TẮT Đặt vấn đề: Nghiên cứu nhằm đánh giá kết quả phẫu thuật nội soi hoàn toàn và phẫu thuật nội soi hỗ trợ cắt toàn bộ dạ dày nạo vét hạch D2 do ung thư tại Bệnh viện Hữu nghị Đa khoa Nghệ An. Phương pháp: Nghiên cứu mô tả hồi cứu, gồm 126 bệnh nhân ung thư dạ dày được phẫu thuật nội soi hoàn toàn và phẫu thuật nội soi hỗ trợ cắt toàn bộ dạ dày vét hạch D2, từ 2013 đến 2020 Kết quả: Tuổi trung bình 60,6 ± 11,1 tuổi. Tỷ lệ nam/nữ 2.8/1. Ung thư ở giai đoạn I, II, III là 19,0%, 49,2%, 31,7%. Ung thư biểu mô tuyến nhú và ống là 70,6% và tế bào nhẫn là 24,6%. Tỷ lệ tai biến trong mổ của nhóm PTNS hoàn toàn là 4,4% và PTNS hỗ trợ 20,6%. Số hạch nạo vét được trung bình của 2 nhóm PTNS hoàn toàn là 23,7 ± 7,1 hạch và PTNS hỗ trợ là 18,0 ± 7,2 hạch. Lượng máu mất trung bình của PTNS hoàn toàn 30,56 ± 10,2 ml và PTNS hỗ trợ 36,11 ± 9,9 ml. Thời gian phẫu thuật trung bình của nhóm PTNS hoàn toàn là 206,4 ± 30,6 phút và PTNS hỗ trợ 220 ± 40,9 phút. Tỷ lệ biến chứng sau mổ của nhóm PTNS hoàn toàn là 4,4% và PTNS hỗ trợ là 22,3%. Thời gian nằm viện trung bình của nhóm PTNS hoàn toàn là 7,5 ± 2,1 ngày và PTNS hỗ trợ là 10,2 ± 2,4 ngày. Kết luận: Phẫu thuật nội soi hoàn toàn và phẫu thuật nội soi hỗ trợ cắt toàn bộ dạ dày nạo vét hạch D2 do ung thư là kỹ thuật an toàn và hiệu quả trong điều trị ung thư dạ dày. ABSTRACT EVALUATION OF OUTCOMES TOTALLY LAPAROSCOPIC TOTAL GASTRECTOMY AND LAPAROSCOPIC - ASSISTED TOTAL GASTRECTOMY WITH D2 LYMPH NODE DISSECTION DUE TO CANCER Introduction: To evaluate the results of totally laparoscopic total gastrectomy (TLTG) and laparoscopicassisted total gastrectomy (LATG) with D2 lymph node dissection to treat gastric cancer in the Nghean General Friendship Hospital. Materials and Methods: In a retrospective cohort study, 126 patients with gastric cancer underwent TLTG and LATG with D2 lymph node dissection between 2013 and 2020. Results: There were 126 patients with an average age of 60.6 ± 11.1 years. The male/female ratio was 2.8/1. The percent of patients with tumors at stages I, II, III were 19.0%, 49.2%, 31.7%, 70.6% of patients had papillary adenocarcinoma and tubular adenocarcinoma. Patients with ring cell carcinoma wereaccounted for 24.6%. The total percent of incidents during the surgery of the group of TLTG was 4.4%, and the group of LATG was 20.6%. The average number of harvested lymph nodes in the group of TLTG was 23.7 ± 7.1, and the group of LATG was 18.0 ± 7.2. The average blood loss in the group of TLTG was 30.56 ± 10.2 ml, and the group of LATG was 36.11 ± 9.9 ml, and the average operation time in the group of TLTG was 206.4 ± 30.6 minutes, and the group of LATG was 220 ± 40.9 minutes. The total percent of postoperative complications in the group of TLTG was 4.4%, and the group of LATG was 22.3%. The hospital stays in the group of TLTG was 7.5 ± 2.1 days, and the group of LATG was 10.2 ± 2.4 days. Conclusions: TLTG and LATGwith D2 lymph node dissectionwere safe and effective in treating gastric cancer. Keywords: Laparoscopic gastrectomy, gastric cancer, total gastrectomy


2019 ◽  
Vol 1 (2) ◽  
pp. 110-121
Author(s):  
Sandrie Mariella Mac ◽  
Ashish Bahadur Malla

For many decades, D2 procedure has been accepted in the far-east as the standard treatment for both early (EGC) and advanced gastric cancer (AGC). In case of AGC, the debate on the extent of nodal dissection has been open for many years in order to highlight the safety and efficacy of treatment, hence this study. A comprehensive literature research was performed in PubMed to identify studies that compared laparoscopic- assisted gastrectomy (LAG) and open gastrectomy (OG) with D2 lymph node dissection (D2-LND) for treatment of AGC for the last five years. Data of interest were checked and subjected to meta-analysis with RevMan 5.3 software. The pooled risk ratios (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI) were calculated. Overall, 19 studies were included in this meta-analysis. LG had some advantages over OG, including shorter hospitalization (WMD -2.31; 95% CI -4.09 to -0.53; P = 0.01), less blood loss (WMD -120.49; 95% CI -174.27 to -66.71; P < 0.01), faster bowel recovery (WMD -0.55; 95% CI -0.86 to -0.24; P ˂ 0.01) and earlier ambulation (WMD -0.75; 95% CI -1.38 to -0.11; P = 0.02). In terms of surgical and oncological safety, LG could achieve similar lymph nodes (WMD, -0.94, 95% CI, -2.95 to 1.06; P=0.36), a lower complication rate [odds ratio (OR)=0.80; 95%CI, 0.68-0.97; P=0.02], and overall survival (OS) and disease-free survival (DFS) comparable to OG. In conclusion, for AGCs both techniques (LAG and OG) appeared comparable in short- and long-term results. More time was needed to perform LAG; nonetheless, it had some advantages in achieving faster postoperative recovery over OG. In order to clarify this controversial issue ongoing trials and future studies are needed.


2011 ◽  
Vol 21 (6) ◽  
pp. 383-390 ◽  
Author(s):  
Hong-Bo Wei ◽  
Bo Wei ◽  
Cui-Ling Qi ◽  
Tu-Feng Chen ◽  
Yong Huang ◽  
...  

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