Stomach Stump Research Articles

A clinical case: gastric cancer after gastric bypass

Introduction: Gastric cancer is one of the most common oncological diseases in the world, occupying the 5th place of morbidity and the 3rd place in the structure of mortality from oncological diseases. For a long time, issues affecting the risk of developing cancer after bariatric surgery remain relevant. Our observation is devoted to the diagnosis and treatment of a patient with gastric cancer after gastric bypass. Description of the clinical case: A 62‑year‑old patient was operated on 13. 07. 2016 – laparoscopic Roux gastric bypass for morbid obesity, 11. 09. 2019 – laparoscopic installation of the Cardioplant plate on a small stomach due to recurrent weight gain. Since 2020 the patient had the phenomena of anastomositis, dysphagia and gastroesophageal reflux. Courses of conservative therapy, sessions of balloon dilation of gastroenteroanastomosis and anastomosis resection failed to show a significant effect. The patient underwent comprehensive examinations at each treatment, including abdominal MSCT, cancer markers and studies of biopsy material of the gastric mucosa and gastroenteroanastomosis. As a result of histological studies, no signs of cancer were found. After applying to the Avicenna Medical Center in 2022 a molecular genetic analysis was carried out, in which the mRNA panel most corresponded to a malignant neoplasm. 20. 12. 2022 extirpation of the stomach stump with resection of the esophagus was performed. The cancer diagnosis was confirmed by histological and immunohistochemical studies: low‑grade adenocarcinoma of the stomach with a cricoid component with germination into the esophagus and small intestine, with spread beyond the muscle layer. Conclusion: This clinical case highlights the complexity of oncological verification in patients after bariatric surgery. Prolonged dysphagia, anastomositis and recurrent GERD in such patients determine the need for a more detailed examination, including the latest achievements of molecular genetic analysis.

The possibilities of cytoreductive operations in recurrent abdominal pain syndrome in cancer patients, occurring under the mask of acute pancreatitis

Among the diseases of urgent pathology, the leading place belongs to acute pancreatitis, which is inferior to such nosologies as acute appendicitis and acute cholecystitis. Moreover, the lion’s share is occupied by light forms, which make up 85%. The aim of the work is to demonstrate a clinical case of recurrent abdominal syndrome occurring under the mask of acute pancreatitis in a patient with oncopathology identified using a diagnostic algorithm used in outpatient practice. Material and methods. Patient F., 60 years old, repeatedly sought medical help in a network of polyclinics and hospitals providing emergency specialized medical care with recurrent abdominal syndrome. Results and discussion. Against the background of conservative treatment, the patient had a short-term positive dynamics characteristic of a mild form of acute pancreatitis. After taking the patient to the dispensary and conducting an in-depth diagnostic examination according to the algorithm developed by our group of researchers, cancer of the stomach stump T2N0M0 was detected. Conclusion. Patients with recurrent abdominal pain syndrome need dispensary observation on an outpatient basis to identify other pathology occurring under the guise of acute pancreatitis and to conduct adequate treatment.

A RARE COMPLICATION OF THE OPERATED STOMACH DISEASE WITH THE FORMATION OF AN EXTERNAL GASTRIC FISTULA

Summary. Stomach and duodenum ulcer occupies a leading place among the surgical diseases of the digestive organs (6–10 % of the population). Operated stomach diseases can be occurred in operated patients as a complication of resections (up to 35 % of cases), and often requires timely diagnosis and repeated invasive reconstructions of the gastrointestinal tract. The aim of the research is to present a clinical case of patient with an atypical course of the operated stomach disease and to highlight the main stages of the diagnostic and treatment algorithm.
 Materials and methods. Analysis of medical publications for the last 5 years, devoted to the clinic, diagnosis and treatment of the operated stomach disease, and analysis of a clinical case of a patient with a rare complication of this pathology.
 Results and discussion. The presented patient underwent Billroth II stomach resection for duodenum peptic ulcer in 2016. In 2021, a left chest wall fistula with suppuration appeared. According to the examination in the hospital (contrast fistulography followed by fibroesophagogastroscopy), the penetration of the stomach stump peptic ulcer into the left costal rib arch with the formation of an external gastric fistula was discover. The patient was operated on using «Laparotomy, stomach resection followed by end-to-end gastroenteroanastomosis reconstruction, Roux entero-enteroanastomosis» with simultaneous excision of the left costal rib arch fistula. In the postoperative period, the wounds healed per prima. The patient was discharged in satisfactory condition.
 Conclusions. The presented case is a casuistic rare complication of the operated stomach disease. Contrast fistulography followed by fibroesophagogastroscopy is useful to establish the cause of the fistula, which is an indication for repeated reconstructive surgery on the stomach stump and gastroenteroanastomosis with excision of the rib arch fistula. To prevent this complication, we recommend scheduled fibroesophagogastroscopy once a year.

Modern principles of prevention of early postoperative complications in bariatric surgery (review of literature)

The article presents the problem of the development of complications of bariatric surgery in the early postoperative period. After the start of the use of endovideosurgical technologies in bariatric surgery, the incidence of general surgical complications in the early postoperative period dropped sharply to 2-6 %. Nevertheless, serious complications still arise, the frequency and type of which largely depends on the patient's comorbidity and the complexity of the operation. The most formidable and difficult complication in treatment is the failure of the sutures of the stomach stump (stapler line), which is more often characteristic of longitudinal resection of the stomach and occurs in 1.5-2.4 % of cases. Deep vein thrombosis is another serious complication in bariatric surgery - the incidence ranges from 2.4 to 4.5 %. Bleeding is no less serious complication of obesity surgery. The frequency of repeated interventions associated with bleeding in the early postoperative period is 11 %. Moreover, in 85 % of cases, conservative methods of stopping bleeding are successful. Considering that the permissible operational lethality of bariatric operations should not exceed 0.1 %, the issues of developing a unified concept of prevention methods to reduce the incidence of complications in patients with morbid obesity remain relevant.

Comparative study of the morphofunctional state of the stomach stump after various options for gastric bypass

<h3>ОБОСНОВАНИЕ</h3> На долю гастрошунтирования по Ру (РуГШ) приходится около 45% всех бариатрических вмешательств. Минигастрошунтирование (МГШ) было разработано как альтернатива РуГШ. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Оценка морфофункционального состояния слизистой оболочки (СО) культи желудка после МГШ и РуГШ с использованием индекса билиарного рефлюкса (BRI). <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включены результаты сравнительного анализа хирургического лечения 121 пациента: 58 пациентов, перенесших МГШ (группа МГШ), и 63 пациентов, перенесших РуГШ (группа РуГШ). В отдаленном послеоперационном периоде у всех пациентов оценивали наличие признаков рефлюкса с помощью видеогастроскопии с прицельной биопсией СО культи желудка и микроскопии биопсийных материалов. Исследование зарегистрировано на сайте ClinicalTrials.gov под номером NCT04845438. <h3>РЕЗУЛЬТАТЫ</h3> Период наблюдения пациентов составлял от 36 до 64 мес, средняя длительность периода — 42,6±4,5 мес. Анализ результатов по данным опросника Gastroesophageal Reflux Disease-Health-Related Quality of Life показал, что выраженность симптомов гастроэзофагеальной рефлюксной болезни и их влияние на качество жизни статистически значимо различались между исследуемыми группами. В 19% случаях в группе РуГШ и в 44,8% случаях в группе МГШ наблюдались признаки активного гастрита культи желудка (<i>p</i>&lt;0,05). В группе РуГШ BRI &gt;14 баллов был определен у 3 (4,8%) пациентов, в группе МГШ BRI &gt;14 баллов — у 20,7% пациентов, различия статистически значимы (<i>p</i>&lt;0,05). Таким образом, число пациентов с BRI &gt;14 баллов статистически значимо больше в группе МГШ. <h3>ЗАКЛЮЧЕНИЕ</h3> На основании полученных данных рекомендуем МГШ как эффективный метод бариатрической хирургии. Однако такие пациенты нуждаются в постоянном контроле ввиду высокого риска развития рефлюкс-ассоциированных осложнений для отбора кандидатов на ревизионную операцию и переход в РуГШ.

Diagnostic approach and treatment specificity in patients with focal lesions of the biliopancreatic area complicated by mechanical jaundice.

Pancreatoduodenal resection (PDR) represents one of the most demanding procedures which is required in patients with a tumoral lesion at this level. The aim of the present article was to report the results of 272 patients submitted to such surgical procedures. All patients were divided into two groups: the main group, for whom the optimized decompression algorithm was used (n=112) and the control group, for whom preparation for PDR was carried out according to generally accepted standards (n=160). Upon admission to the hospital, the total bilirubin level in the main group was 274.6±5.9 µmol/l while in the control group this level was 270.4±4.6 µmol/l. PDR was performed in 272 of the patients. Whipple's terminolateral anastomosis was performed in 38/160 (23.7%) of patients in the control group; termino-terminal anastomosis according to Shalimov-Kopchak's method was imposed in 40/160 (25.0%) patients of the control group. Pancreatojejunoanastomosis with the imposition of a ductomucosal anastomosis was performed in 128 patients in total with 73 cases in the main group and in 55 cases in the control one. Pancreatogastroanastomosis with plunging of the pancreatic stump into the stomach stump was performed in 35 patients in total with 19 patients in the main group and 16 in the control group. Pancreatogastroanastomosis with plunging of the pancreatic stump into the 'stomach sleeve' was performed in 32 patients in total with 20 patients in the main group and 12 in the control group. The mortality rate in the main group was 6.3% (7 patients), and in the control group, 11.9% (19 patients). In conclusion, biliary decompression may improve the postoperative outcomes after pancreatic resection.

Biliary reflux after laparoscopic modified antireflux monoanastomotic gastric bypass surgery

Aim. Determination of biliary reflux in patients with morbid obesity after a single-anastomotic gastric bypass operation performed in the clinic's modification and according to the classical Roux-en-Y gastric bypass technique. Development of diagnostic criteria for biliary reflux Materials and methods. The results of treatment of 36 patients with morbid obesity who underwent bypass surgery were studied. The patients are divided into two groups. Clinically modified laparoscopic monoanastomotic gastric bypass surgery was performed in 25 patients (main group). The control group included 11 patients after the standard technique of Roux-en-Y laparoscopic gastric bypass. Inclusion criteria were: persons of both sexes aged 18-60 years with morbid obesity and a body mass index of 40 or more, as well as 35 or more in the presence of comorbid diseases (type 2 diabetes mellitus, arterial hypertension, dyslipidemia, sleep apnea syndrome). In both groups, impedance pH measurements were performed in the postoperative period. Statistical processing was performed using the Statistica 13.0 software package using parametric and nonparametric statistical methods. Results: Clinical manifestations of the enterogastric biliary reflex were found in both groups; in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. The analysis of daily pH-metry in the studied groups showed that in the esophagus the time with pH &lt;4 in the main group 2.83 (1.55; 3.95)% 3.00 (2.30; 3.50)% in the control group, time with pH 4-6.9 (physiological for the esophagus) 92.40 (90.65; 94.20)% and 94.10 (89.80; 95.50)%, respectively, time with pH&gt; 7 (weak alkaline) was 4.80 (3.45; 5.85)% and in the control group 2.90 (1.20; 7.20)%. There was no statistically significant difference in these indicators (p&gt; 0.05). Conclusions. Monoanastomotic gastric bypass surgery in the modification of the clinic has the same positive properties as the Rouen-Wye technique, allowing you to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone mini-gastric bypass surgery require a thorough examination with fibrogastroscopy in combination with pH impedance measurement at least 1 time per year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stomach stump. The level of quality of life of patients after surgery in the control group and the main group does not significantly differ, as evidenced by the results of the questionnaire survey using the GERG Q questionnaire, which indicates the effectiveness of the methodology of laparoscopic monoanastomotic gastric bypass surgery modified in the clinic. Key words: morbid obesity, gastric bypass surgery, surgical treatment, mini-gastric bypass, biliary reflux.

To X-ray diagnostics of malignant neoplasms in patients with operated stomach

The decisive method for the treatment of malignant neoplasms of the stomach is surgical intervention. The successes achieved in this direction are limited mainly to surgery for primary cancer of the stomach. Patients with recurrent tumors in the stomach stump, as well as with secondary malignant neoplasms in this area after surgery for peptic ulcer, polyps and other diseases, were considered doomed and hopeless until recently.

To the technique of anastomosis for gastric resection for cancer

In weakened and emaciated gastric cancer patients who have been radically operated on, in the immediate postoperative period, quite often a number of complications are noted. The most common congestion in the cult of the stomach and duodenum - expansion of the stomach stump and stasis of the duodenum.

Influence of the gastric stump’s volume on the long-term results of laparoscopic Roux-en-Y gastric bypass surgery

The objective was to retrospectively analyze the dependence of long-term results of laparoscopic Roux-en-Y gastric bypass surgery according to the size of the formed gastric stumpMethods and materials. We retrospectively analyzed the long-term results of 207 morbidly obese patients who underwent laparoscopic Roux-en-Y gastric bypass surgery by two different techniques. The median follow-up was 36 months. Two groups of patients were identified according to the method of formation of the gastric stump: using 2 (1st group) or 3 (2nd group) stapler cassettes and performing of computed tomography volumetry to determine thevolume of the created gastric stump.Results. Statistically significant differences in the volume of the formed gastric stump, depending on the method of operation, were as follows: 23.8 ml (8.9–37.3 ml) in the 1st group and 47.7 ml (31.9–72.8 ml) in the 2nd group (p&lt;0.0001). Significant differences were observed in the following indicators: relapse of weight gain or insufficient weight loss (loss of &lt; 70 % overweight) at median follow-up of 36 months were observed in 2 (2.3 %) and 12 (9.9 %) cases in the 1st and 2nd groups, respectively (p&lt;0.05).Conclusion. We revealed that the formation of the gastric stump of a very small volume by 2 stapler cassettes compared to using 3 stapler cassettes contributes to improving the results in the long-term postoperative period and minimizing the frequency of relapse of weight gain and insufficient weight loss. The restrictive component of the surgery with equal malabsorptive is fundamental for the clinical parameters of its effectiveness, that leads to increasing the frequency of relapses of weight gain and insufficient weight loss in the 2nd group in comparison with the 1st and group of patients (p&lt;0.05). Based on computed tomography volumetry, the volume of a small-sized stomach stump can be reliably measured and, accordingly, weight loss is predicted in the long term after the surgery, as well as the absence of relapses of weight gain or insufficient weight loss.

A new algorithm of preoperative preparation of patients with focal lesions of the biliopancreatic area complicated by mechanical jaundice

Pancreatoduodenal resection (PDR) represents one of the most demanding procedures which is required in patients with a tumoral lesion at this level. The aim of the present article was to report the results of 272 patients submitted to such surgical procedures. All patients were divided into two groups: the main group, for whom the optimized decompression algorithm was used (n=112) and the control group, for whom preparation for PDR was carried out according to generally accepted standards (n=160). Upon admission to the hospital, the total bilirubin level in the main group was 274.6±5.9 µmol/l while in the control group this level was 270.4±4.6 µmol/l. PDR was performed in 272 of the patients. Whipple’s terminolateral anastomosis was performed in 38/160 (23.7%) of patients in the control group; termino-terminal anastomosis according to Shalimov-Kopchak’s method was imposed in 40/160 (25.0%) patients of the control group. Pancreatojejunoanastomosis with the imposition of a ductomucosal anastomosis was performed in 128 patients in total with 73 cases in the main group and in 55 cases in the control one. Pancreatogastroanastomosis with plunging of the pancreatic stump into the stomach stump was performed in 35 patients in total with 19 patients in the main group and 16 in the control group. Pancreatogastroanastomosis with plunging of the pancreatic stump into the ‘stomach sleeve’ was performed in 32 patients in total with 20 patients in the main group and 12 in the control group. The mortality rate in the main group was 6.3% (7 patients), and in the control group, 11.9% (19 patients). In conclusion, biliary decompression may improve the postoperative outcomes after pancreatic resection.&#x0D; Abbreviations: CEA, carcinoembryonic antigen; CA, cancer antigen; PDR, pancreatoduodenal resection; MRI, magnetic resonance imaging

Anatomical Changes During Laparoscopic Procedures

Determining the exact sizes of anatomical structures play a very important today in laparoscopic surgery. This makes it possible to make a correct selection of gauges of instruments needed, prosthetic materials, and to make decisions regarding the further strategy of the surgical procedure. The device developed at the clinic has proven itself in everyday clinical practices. It is currently used in laparoscopic operations for hiatal hernias, choledoch measurements in patients with choledocholithiasis, stomach stump size measurements during the resection in patients with morbid obesity. The presented clinical case serves to confirm that obtaining objective data in video endoscopic surgery makes it possible to choose the optimal treatment strategy.

Fluorescence angiography for blood flow assess during right hemicolectomy. Case study

Fluorescent laparoscopy enables to visualize blood vessels and blood flow in the organs of the gastrointestinal tract, which can be used in colon resection. Laparoscopic right hemiclectomy was performed in a patient aged 55 years with an adenomatous polyp of Bauginia flap without dysplasia. The operation was performed through four trocars: 1 — 10 mm, 1 — 13 mm, 2 — 5 mm. During surgery, the hepatic flexure of the colon was saved due to the expressed a. colica dextra. After intracorporal ileotransversoanastomosis formation of with the device Endo GIA‑60 fluorescence angiography was performed: Indocyanine green in a dose of 0.3 mg/kg of body weight was injected intravenously. After 2 minutes, in near‑infrared survey regime, a satisfactory vascularization of the terminal ileum mesentery and accumulation of the fluorescing substance in the walls of the ileum and the stomach stump, in particular the finite regions of the stump, have been achieved. Regarding the received data, there was no risk of failure of anastomosis and bowel stump. The operation was completed on a planned extension. No technical difficulties with fluorescence angiography were found. Allergic reactions to the administered drug and the failure of anastomosis were not. The first experience of using fluorescence angiography for assessing blood supply in the anastomosis area during resection of the colon demonstrated the convenience and safety of the technique. Fluorescence angiography helped to evaluate the blood supply to intestinal walls and mesentery, which allowed to execute a limited variant of operation with the preservation of hepatic flexure of the colon with blood supply from a. colica dex.

Comparative Evaluation of Gastroduodenostomy and Gastrojejunostomy for Stomach Reconstruction Following Partial Gastrectomy in Dogs

The present experimental study was aimed to perform partial gastrectomy through surgical excision the distal part of the stomach in dogs (approximately 1/5 stomach size), and then performing two types of reconstruction techniques: Gastroduodenostomy (Billroth I) and Gastrojejunostomy (Billroth II). The current experimental study was carried out on 10 apparently healthy mongrel dogs (7 males and 3 non-pregnant females), aging (8 months to 2 years old) and weighing (12 to 30 kg). Two types of surgical technique were used: A. Billroth I (Gastroduodenostomy): Partial gastroectomy with gastroduodenal anastomosis (5 dogs were used) B. Billroth II (Gastrojejunostomy): Partial gastroectomy with gastrojejunal anastomosis (5 dogs were used). All dogs recovered from anesthesia with no complications during the surgery and recovery. There was no evidence of wound infection. Dogs started to eat on Day 3 after surgery without any sign of regurgitation. No serious postoperative complications were observed. There were no signs of premature vasomotor disturbances, such as dizziness, weakness and alimentary disorders. One month after surgery radiographic findings cleared that there was neither stricture, narrowing, obstruction nor leakage at site of anastomosis in both groups. On conclusion; Both Billroth I and Billroth II might be considered as suitable approaches for reconstructing gastro-intestinal tract following partial gastrectomy in dogs with no particular difference in clinical and para-clinical parameters in dogs. Billroth I doesn’t change the normal anatomy and function of the digestive system as performed anastomosis of the stomach stump to the duodenum, it’s conductive to the digestion of food falling from the stomach into the intestine mixing with pancreatic, duodenal and biliary secretion while in Billroth II mixing process occurs in the jejunum. The time consumed during Billroth II operation was higher than Billroth I also the risk adjusted complication rate was also higher in Billroth II group. Billroth I method should be the first choice after a distal gastrectomy as long as the anatomic and oncological environment allows us to perform it.

Operation on Billroth-I in gastric cancer surgery: the evolution of views

In recent years almost all over the world, there is a decrease in the incidence of gastric cancer. Despite that carcinoma of the stomach annually affects on our planet about 1 million people. The prevalence of distal gastric cancer has a tendency to decrease, while the frequency of proximal cancer increases slightly. Early gastric cancer is only 10% of all new cases, and in 64,2% of patients are diagnosed at stages III-IV disease. Over the last 35 years, there has been substantial progress in the diagnosis and treatment of gastric cancer. Surgery that involves complete removal of the tumor remains the only method which gives hope for cure of the patient, despite the significant number of combined and complex treatment methods of this disease. However, many provisions of this concept have changed drastically. After surgery Billroth-I much less frequently and with less severity (than after resection Billroth-II) develops duodenogastric reflux in the absence of duodenostasis and adequate patency of the digestive tract. It is the reflux of bile and pancreatic juice plays an important role in the occurrence of cancer of the stomach stump. The basic cause of cancer is the development of atrophic gastritis as a consequence of denervation of the authority and the reflux of bile into the resected stomach. The choice of the method of restoring the integrity of digestive tract after distal gastrectomy is a topical problem, given the continuous increase in the number of patients undergoing this operation. In the review of literature shows that intervention in the modification of the Billroth-I does not increase the number of postoperative complications, no differences in long-term results of surgical treatment of gastric cancer for two methods of restoring the continuity of the digestive tract after distal resection.

Hepatic arterial reconstruction using saphenous vein graft interposition for distal pancreatectomy with celiac axis resection

Objective: We report two cases required hepatic arterial reconstruction during distal pancreatectomy with celiac axis resection (DP-CAR). Methods: Case 1, 54 years old male patent underwent DP-CAR for his pancreas cancer. As radical antegrade modular pancreatosplenectomy (RAMPS) approach, Common hepatic artery was resected first then isolation of inferior pancreatoduodenal artery (IPDA) from supra mesenteric artery (SMA) was attempted. However IPDA was injured then hepatic arterial flow was lost. Total pancreatectomy and subtotal gastrectomy was performed to avoid pancreatic fistula and ischemia of the stomach. Then hepatic arterial reconstruction using saphenous vein graft interposition between infra-renal abdominal aorta and proper hepatic artery was performed. Case 2, 75 years old male patient underwent DP-CAR using RAMPS for his pancreas cancer. After lost hepatic arterial flow due to IPDA injury, saphenous vein graft was immediately harvested to minimize ischemia time. DP-CAR was performed and the stomach was preserved, then arterial reconstruction was performed as same as case 1. Results: Case 1, Hemorrhage from stomach stump was remarkable in his postoperative course. The patient is having malnutrition but not suffered from recurrence for 7 months after the surgery. Case 2, The patient developed delayed postoperative pancreatic fistula and bleeding from SMA. The patient died at postoperative day 82. Conclusion: RAMPS for DP-CAR may have a pit fall to keep hepatic arterial flow safe. The hepatic artery reconstruction using saphenous vein graft was feasible in our series. However reconstruction of the gastric arterial flow and minimize ischemia time should be considered for longterm prognosis.

Helicobacter pyloriinfection following partial gastrectomy for gastric cancer

Gastric remnants are an inevitable consequence of partial gastrectomy following resection for gastric cancer. The presence of gastric stumps is itself a risk factor for redevelopment of gastric cancer. Helicobacter pylori (H. pylori) infection is also a well-known characteristic of gastric carcinogenesis. H. pylori colonization in the remnant stomach therefore draws special interest from clinicians in terms of stomach cancer development and pathogenesis; however, the H. pylori-infected gastric remnant is quite different from the intact organ in several aspects and researchers have expressed conflicting opinions with respect to its role in pathogenesis. For instance, H. pylori infection of the gastric stump produced controversial results in several recent studies. The prevalence of H. pylori infection in the gastric stump has varied among recent reports. Gastritis developing in the remnant stomach presents with a unique pattern of inflammation that is different from the pattern seen in ordinary gastritis of the intact organ. Bile refluxate also has a significant influence on the colonization of the stomach stump, with several studies reporting mixed results as well. In contrast, the elimination of H. pylori from the gastric stump has shown a dramatic impact on eradication rate. H. pylori elimination is recognized to be important for cancer prevention and considerable agreement of opinion is seen among researchers. To overcome the current discrepancies in the literature regarding the role of H. pylori in the gastric stump, further research is required.

Analyses of surgical treatment and prognosis in gastric stump cancer

To evaluate the efficacy of surgical treatment and the prognosis in gastric stump cancer patients. Between June 1994 and March 2004, 692 patients underwent radical operation for gastric cancer in our department. Among them, 22 cases were gastric stump cancer. Their surgical treatments, lymph node metastasis and survival were analyzed retrospectively. Gastric stump cancer accounted for 3.2 % of all the gastric cancer cases in the same period. There were 4 cases of stage I, 2 cases of stage II, 6 cases of stage III and 10 cases of stage IIII respectively. Radical excision was 77.3% and combined evisceration was 50.0%. Total gastrectomy were performed in 21 cases and exploratory laparotomy in 1 case. Digestive tract was reconstructed with Roux-en-Y pattern after total gastrectomy. Radical gastric stump cancer excisions were finished with abdominal incision in 18 cases and with thoraco-abdominal incision in 4 cases. Lymph node metastasis rate was 63.6 %, including pN(0) 8 cases, pN(1) 6 cases, pN(2) 7 cases and pN(3) 1 case respectively. Average survival time was(80.2+/-17.2) months in stage I( and II( gastric remnant cancer; average survival time was(31.2+/-9.2) months in stage III( gastric remnant cancer, average survival time was (23.6+/-6.1) months in stage IIII( gastric remnant cancer, which were significantly different(all P<0.05). Between palliative operation group and standard radical excision, extended radical excision groups, well-moderate differentiated and poor differentiated adenocarcinoma groups, lymph node metastasis positive and negative groups, the differences were all significant. Total gastrectomy and D(2) lymph node dissection are imperative for radical excision of gastric remnant cancer. On this base, extended lymphectomy and combined evisceration should be performed appropriately. Tumor stage, procedure pattern, lymph node metastasis and tumor differentiation affect the prognosis of patients with gastric stump cancer.

The level of MAP kinase activity in the stomach stump in rats after subtotal gastrectomy

MAPK (Mitogen-Activated Protein Kinase) is one of the elements of kinase cascades (MAPK, MEK-MAP kinase, kinase, Raf-1, Ras) regulating cellular proliferation and differentiation processes. It seems that the changes in its number and activity may be the factor having influence on carcinogenesis. In some human carcinomas a significant increase of its activity is observed, in others a decrease of its activity is described. Our research aimed at the evaluation of the dynamics of precancerous and cancerous changes in the stomach stump in rats after the experimental, partial stomach resection. Apart from histological and ultrastructural examination we also determined the activity of the sub-unit p42 MAP kinase. The material comprised segments of gastric mucosa of the stomach stump of 15 rats after subtotal gastrectomy. Part of the rats after the procedure were administered carcinogen orally (MNNG). On the histological and ultrastructural examination we used routine methods, the activity of MAP kinase was determined by western-blotting method with the use of IgG against MAPK p42, Santa Cruz #154). In 8 examined rats we observed the increase of MAP kinase activity. We established probable correlation (without statistical analysis, regarding miserly material) between the increase of MAPK activity and histological and ultrastructural changes. Among three cases diagnosed as adenoma tubulare in two we observed the increase of MAPK activity. A clear increase of this kinase was also present in the stomach stump of a rat, which was diagnosed as adenocarcinoma. On the basis of our research carried so far we think that the increase of the MAPK activity may be one of the causes of the neoplasm development. It seems important to obtain the confirmation of our results and to establish a possible usefulness of MAPK activity determination as a prognostic indicator in case of the neoplasm of stomach stump.

Roentgenology of cancer of the gastric stump

The carcinoma of the stomach stump is a late complication after partial resection of the stomach and gastroenterostomy. The risk for carcinoma increases with the interval, but in older people the interval is shorter. 12 patients with carcinoma of the stomach stump are discussed. The average interval from the primary operation of the stomach until the carcinoma was 23.8 years. With x-ray examination the diagnosis was correct in 11 patients, in 1 patient the examination was interpreted falsely.