Postoperative External Transabdominal Severe Lymphorrea (Case Report)

Massive lymphorrhea can cause severe dysfunction of organs and systems and result in death due to loss of vital metabolites from the bodyAim. To demonstrate low efficacy of conservative therapy and late lymph duct ligation in continuous massive postoperative lymphorrhea.Results. We treated a patient with previous subtotal gastric resection with single-plane pancreatic resection, D2 lymph node dissection, peritoneal draining due to poorly differentiated carcinoma in the lower third of stomach and total hysterectomy who developed external lymphorrhea through peritoneal drainage tubes 3 days after surgery. A fat-rich diet, endolymphatic sodium etamsylate administration, and lymphatic duct ligation were not successful in terminating the lymph leakage. Despite the intensive care including extracorporeal detoxification, the multi-organ failure progressed and on day 28 after the surgery the patient was pronounced dead.Conclusion. Damage to lymph ducts and lymph nodes can be complicated by massive lymphorrhea. If the source of lymphorrhea can be identified, an urgent surgical intervention is warranted to stop the lymph leakage, as well as the restoration of homeostasis to replenish the lost metabolites and prevent death of the patient.

Features of Histological Forms of Tumor Growth in Patients Who Underwent Combined Surgery for Stomach Cancer

The morphological type of tumor is a crucial factor in selecting the type and volume of surgery.The objective of the research was to determine the effect of tumor histological type on survival rates in patients with locally advanced stomach cancer after combined surgery.Materials and methods. The study included 990 patients; there were 714 men and 276 women. All patients underwent combined surgery: distal subtotal gastric resection was performed in 222 cases; proximal subtotal gastric resection was used in 129 cases; gastrectomy was applied in 639 cases. Statistical analysis of the obtained data was performed using the SPSS 13.0 software program. The results were considered statistically significant at p<0.05.Results. The study of certain morphological types of tumor depending on the patients’ age and sex, as well as clinical and morphological features revealed a significant predominance of adenocarcinoma (77.1%) over other types and a significantly smaller number of undifferentiated tumors – 20.6%; squamous cell cancer and small-cell cancer constituted 1.3% and 1.0%, respectively. The average life expectancy after surgery was 37.51±2.69 months (p=0.021); in women, it was slightly higher compared to men – 43.75±5.70 months vs. 35.13±3.02 months (p=0.057). The overall 5-year survival rate for all patients was 17.32±1.49%; for men – 16.11±1.72% (p=0.005), for women – 20.46±2.99% (p=0.399); however, these differences were not statistically significant (p=0.087).Conclusions. After surgery, there were no significant differences in the average life expectancy of patients with the same histological forms of gastric adenocarcinoma between men and women (p>0.05), while significant differences were observed between patients (both men and women) with adenocarcinoma and undifferentiated adenogenic stomach cancer (p<0.05).