Ways to solve the issues of surgical treatment of stomach cancer

Abstract

Surgical method is the only effective method of stomach cancer treatment. On the basis of dividing the stomach into angiological segments, lymphogenic metastasis was studied, classification of gastric cancer and extraligamentous lymph nodes localizations was created. Based on the performed surgeries working classification of extended lymphodissection was suggested. The data on the formation of esophageal-intestinal anastomosis, identification of the origin of key complications after gastrectomy are given. By introducing single-raw esophago-jejunal anastomosis it was possible to almost completely eliminate complications leading to death which together account for up to 90% of the complications: suture failure, pancreatitis and pancreatic necrosis. The volume of the resected stomach was revised without worsening long-term treatment results. During gastrosplenectomies for ablastic block dissection of lymph nodes the author proposes standard binding of the splenic vessels - proximal to the left gastroepiploic artery arising from the splenic artery. The remaining part of the pancreas after gastrosplenectomy with pancreas resection is proposed to be stitched using atraumatic sutures, which avoids formation of pancreatic fistula. In the clinic we developed esophagogastrosplenectomy from laparoscopic mediastinal access with isoperistaltic right colon graft for esophageal reconstruction with anastomosis located in the neck, antethoracic esophageal reconstruction with graft from the large curvature of the stomach, as well as created original drainages of our own design, which allowed excluding peritonitis without inconsistency of the sutures and abscesses of the abdominal cavity. The author concludes that gastrectomy and subtotal distal gastric resection according to his original methods are an effective tool in the surgical treatment of gastric cancer.