Surgical Treatment Of Gastric Cancer Research Articles

Long-term Outcomes of Gastric Cancer in a Small Institute: a Single Surgeon Experience

The aim of our study was to analyze the short-term and long-term outcomes of gastric cancer patients who underwent surgical treatment in a small, single institute by one surgeon. We retrospectively reviewed the medical records of 950 patients who underwent surgical treatment for gastric cancer between January 2000 and January 2010 at Dong-rae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea. A total of 820 patients were included and analyzed. We divided the time period into 2 groups: 2000–2005 (period 1) and 2006–2010 (period 2). Since all of the surgeries were performed by a single surgeon, we were able to analyze the effect of increasing individual surgeon experience. The mean follow-up period was 78.26 months. The 5-year overall survival and relapse-free survival rates of all of the patients were 84.6% and 86.5%, respectively; the postoperative morbidity and mortality rates were 12% and 0.36%, respectively. The relapse-free survival rate was higher in period 2 than in period 1 (82.9% vs 90.2%, p = 0.002). The results of gastric cancer surgery between a small institute and the large institutes were comparable. The increased proportion of early gastric cancer and individual surgeon experience was associated with the improvement in the long-term oncologic outcomes of gastric cancer treatment.

Robotic versus open oncological gastric surgery in the elderly: a propensity score-matched analysis

Although there is no agreement on a definition of elderly, commonly an age cutoff of ≥ 65 or 75 years is used. Even if robot-assisted surgery is a validated option for the elderly population, there are no specific indications for its application in the surgical treatment of gastric cancer. The aim of this study is to evaluate the safety and feasibility of robot-assisted gastrectomy and to compare the short and long-term outcomes of robot-assisted (RG) versus open gastrectomy (OG). Patients aged ≥ 70 years old undergoing surgery for gastric cancer at the Department of Surgery of San Donato Hospital in Arezzo, between September 2012 and March 2017 were enrolled. A 1:1 propensity score matching was performed according to the following variables: age, Sex, BMI, ASA score, comorbidity, T stage and type of resection performed. 43 OG were matched to 43 RG. The mean operative time was significantly longer in the RG group (273.8 vs. 193.5 min, p < 0.01). No differences were observed in terms of intraoperative blood loss, an average number of lymph nodes removed, mean hospital stay, morbidity and mortality. OG had higher rate of major complications (6.9 vs. 16.3%, OR 2.592, 95% CI 0.623–10.785, p = 0.313) and a significantly higher postoperative pain (0.95 vs. 1.24, p = 0.042). Overall survival (p = 0.263) and disease-free survival (p = 0.474) were comparable between groups. Robotic-assisted surgery for oncological gastrectomy in elderly patients is safe and effective showing non-inferiority comparing to the open technique in terms of perioperative outcomes and overall 5-year survival.

Immediate and Long-Term Results of the Spleen-Preserved Operations in the Surgical Treatment of Gastric Cancer

ntroduction. Currently, total gastrectomy with D2 lymphadenectomy is the standard surgical treatment for proximal gastric cancer at the resectable stages (I-III). The issue of advisability of splenectomy as a component of lymphadenectomy remains a controversial one, especially when the tumor is localized in the region of the body or cardiac region of the stomach.The aim of the study was to compare immediate and long-term outcomes, including the quality of life, between spleen preserving and spleen removing surgeries.Methods. The study included 363 patients with gastric cancer II-III stages, localized in the upper and/or the middle third of the stomach, who underwent surgery at the Voronezh Regional Clinical Oncology Hospital and the Voronezh Clinical Hospital of the Russian Railway-Medicine in 2015-2017. All patients were conditionally divided into 2 groups for comparative retrospective analysis. All patients of the first (experimental or spleen-preserved) group (144 patients) were performed R0 total gastrectomy with D2 lymphadenectomy, including splenic hilar nodes (№ 10,11) removal without splenectomy. Patients of the second (control or splenectomy) group (219 patients) were performed R0 total gastrectomy with D2 lymphadenectomy and prophylactic splenectomy (for splenic hilar nodes removal).Results. The average duration of the operation and the volume of blood loss did not differ in both groups. The incidence of early postoperative surgical complications was lower in the spleen-preserved group. Splenectomy was associated with more severe complications of class 4 and 5 according to the Clavien-Dindo classification. Conclusion. Parameters of the 1- and 3-year overall survival rate did not differ in both groups. The results of the GSRS questionnaire were similar in both groups, excluding reflux-esophageal symptoms scale. The reflux scale demonstrated a statistically and clinically significant advantage of spleen preservation.

The C-reactive protein to albumin ratio predicts postoperative complication in patients who undergo gastrectomy for gastric cancer

The aim of this study was to evaluate the preoperative C-reactive protein (CRP) to albumin ratio (CAR) of patients with gastric cancer and to investigate the factors correlated with perioperative complications. From March 2016 to December 2019, 128 patients who underwent curative gastrectomy for gastric cancer were enrolled in a retrospective study. The preoperative cutoff value of the CAR for predicting postoperative complications was 0.265 on receiver operating characteristic (ROC) curve analysis. Clinical characteristics were compared between patients with complications (Clavien-Dindo grade ≥2, n = 20) and without complications (Clavien-Dindo grade <2, n = 108). On univariate and multivariate analyses, estimated blood loss (EBL) during the operation (HR 1.003, p = 0.039) and CAR (HR 2.832, p = 0.045) were independent predictors of postoperative complications. In conclusion, preoperative CAR appears to be a predictor of postoperative complications in the patients undergoing surgical treatment of gastric cancer.

Effectiveness of a comprehensive post-operative health education program in improving quality of life after gastric cancer surgery.

Patients with gastric cancer often experience postoperative problems such as dumping syndrome, abdominal cramps, and nausea, which have profound effects on their mental health and quality of life. Earlier studies have shown that comprehensive health education can dramatically improve the quality of life of cancer patients after surgery. Thus, in this study, we conducted a health education intervention program in patients who had undergone surgical treatment for gastric cancer and evaluated the effectiveness of this program in improving the postoperative quality of life, with an attempt to offer evidence for better postoperative management of gastric cancer patients. Totally, 80 patients with gastric cancer who underwent surgery at our center from February 2018 to February 2019 were equally divided into an observation group and control group according to the random number table method. The observation group was offered with interventions regarding health education, including disease awareness-raising, instructions on behavior and lifestyle, rehabilitation management, and mental health counseling, and the control group received the routine nursing intervention. The quality of life one month before and after surgery was assessed by using the Chinese version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-STO22. The baseline data and quality of life showed no significant differences between the observation group and the control group one month before surgery (both P>0.05). One month after the surgery, the scores of dysphagia, pain/discomfort, reflux symptoms, and emotional issues and overall score in the observation group decreased significantly (34.86±2.170, 38.66±3.08, 32.26±2.76, 49.55±4.20, and 54.26±7.03, respectively), which were also significantly lower than those in the control group (36.33±3.10, 44.29±3.72, 33.64±3.10, 53.56±3.25, and 60.17±7.28, respectively; all P<0.05). The comprehensive health education intervention program can effectively improve the quality of life in patients after gastric cancer surgery and deserves further application in clinical settings.

Surgical treatment of gastric cancer complicated by perforation

The article presents modern views on the tactics and methods of surgical treatment for gastric cancer complicated by perforation and the authors own experience in the treatment of this pathology.

Impact of the anatomical location and the number of metastatic lymph nodes on gastric cancer patient´s survival.

The most serious problem in surgical treatment of gastric cancer includes the area of resection and the extent of lymphadenectomy. The extent of gastric resection is determined by the extent of tumor affection. The aim of radical surgical intervention is to achieve microscopically clear resection line, since R0 resection is the main criterion for the patient´s prognosis. Curative surgical resection for gastric cancer includes the lymph nodes dissection. In the treatment of gastric cancer, there are two views on the importance of lymphadenectomy. The Far East considers that operation improves the survival and the Europe considers that surgery is not curative, but it determines the staging and prognosis. There is also a difference in staging systems. The one from East is importance based on the anatomical location of affected lymph nodes, the second from Europe is based on the number of positive lymph nodes. This work is a retrospective observational study. In the study cohort, comparing the survival of patients according to different classification systems, depending on the N-stage of disease, 119 patients with gastric adenocarcinoma in clinical stage I to III, i.e. without metastasis, who underwent a radical surgical resection with D2 lymphadenectomy, were enrolled. For the evaluation of the survival versus the time after operation, we used Kaplan‒Meier method. To evaluate the correlation between the survival rate and the explanatory variables, Cox regression and Kendall correlation coefficient were used. The median survival, according to different classification systems, depending on the N-stage of the disease, was significantly correlated with the survival for the 6th and 7th editions of TNM classification system for the Japanese classification system, for N-ratio classification system).The new finding was differentiation of patients in groups N1 vs N2 under the 6th TNM classification (HR=0.910249), also a little differentiation in groups N1 vs N2 according to the classification of N-ratio (HR=0.8750926) and equally a poor differentiation in the survival in groups N2 vs N3 according to the 7th TNM classification (HR=0.881797).The strongest correlation reached the Japanese classification system, but not significantly different from the 6th TNM classification system. In the 7th edition of TNM classification system, we then found the weakest correlation with the survival time, but not significantly different from the previous two. Our retrospective study confirmed the strongest correlation between the patient´s prognosis and the anatomic localization of the affected lymph nodes. This correlation was not statistically significant compared to the correlation between patient´s prognosis and the number of positive lymph nodes. It leads us to the conclusion that both classification systems are comparable and the difference is statistically insignificant (Tab. 4, Fig. 8, Ref. 16).

Complex approach in the treatment of postoperative complications of gastrectomy

Relevance. At the present stage of development of on-cology, the level of locally advanced and metastatic can-cer of the stomach is high, in total according to 2017 year stage III and IV were diagnosed with 63.7% of all newly diagnosed cases of gastric cancer. The surgical method is basic in the treatment of stomach cancer. Complications of the surgical treatment of gastric cancer, leading to the impossibility or delay of adjuvant treatment, significantly worsen the rates of relapse-free and overall survival. Due to the large difference in the frequency of complications (from 9% to 32%) with surgical aids, the development of combined methods for their treatment is relevant. Ob-jective. In this clinical case, demonstrated a stepwise ap-proach in the treatment of postoperative complications of gastrectomy using conservative and active surgical meth-ods, including minimally invasive endoscopic technolo-gies. Research materials. A case study of the treatment of complications of combined gastrectomy using a variety of approaches is presented. Research methods. Evalua-tion of treatment tactics for postoperative complications of gastrectomy using conservative, endoscopic and active surgical approaches, in comparison with published data. Results. Using a wide arsenal of therapeutic measures, it was possible to stop severe complications after gastrecto-my. Conclusion. Surgical tactics using minimally invasive technologies in combination with intensive care made it possible to timely eliminate the purulent-septic compli-cations. This clinical case demonstrates the applicability of the simultaneous and sequential use of conservative treatment, active surgical tactics and minimally invasive endoscopic technologies in the treatment of severe com-plications of gastrectomy. The choice of tactics in each specific case of the development of postoperative com-plications should be individual, while the use of only con-servative treatment is associated with less efficiency and greater mortality compared to the combined approach.

LESSONS LEARNED ANALYZING COMPLICATIONS AFTER LAPAROSCOPIC TOTAL GASTRECTOMY FOR GASTRIC CANCER.

ABSTRACT Background: Laparoscopic surgery has been gradually accepted as an option for the surgical treatment ofgastric cancer. There are still points that are controversial or situations that are eventually associated with intra-operative difficulties or postoperative complications. Aim: To establish the relationship between the difficulties during the execution of total gastrectomy and the occurrence of eventual postoperative complications. Method: The operative protocols and postoperative evolution of 74 patients operated for gastriccancer, who were subjected to laparoscopic total gastrectomy (inclusion criteria) were reviewed. The intraoperative difficulties recorded in the operative protocol and postoperative complications of a surgical nature wereanalyzed (inclusion criteria). Postoperative medical complications were excluded (exclusion criteria). For the discussion, an extensive bibliographical review was carried out. Results: Intra-operative difficulties or complications reported correspond to 33/74 and of these; 18 events (54.5%) were related to postoperative complications and six were absolutely unexpected. The more frequent were leaks of the anastomosis and leaks of the duodenal stump; however, other rare complications were observed. Seven were managed with conservative measures and 17 (22.9%) required surgical re-exploration, with a postoperative mortality of two patients (2.7%). Conclusion: We have learned that there are infrequent and unexpected complications; the treating team must be mindful of and, in front of suspicion of complications, anappropriate decision must be done which includes early re-exploration. Finally, after the experience reported, some complications should be avoided.

Application of indocyanine green labeled near-infrared fluorescence laparoscopy in gastric cancer

Objective: With the development of laparoscopic surgery technique, the concept of minimally invasive surgery has gradually gained popularity. Laparoscopic minimally invasive technique applied in the treatment of gastric cancer has been recognized by surgeons. In recent years, the indocyanine green labeled near-infrared fluorescence laparoscopic technique has been gradually applied to the surgical treatment of gastric cancer. This technique overcomes the drawbacks of tactile lack of laparoscopic surgery and makes the laparoscopic surgery of gastric cancer more precise and minimally invasive. This article introduces the injection method of indocyanine green and discusses the application of fluorescent laparoscopy in gastric cancer surgery, including intraoperative tumor localization of early gastric cancer, sentinel lymph node biopsy, lymph node navigation of advanced gastric cancer, digestive tract reconstruction and gastrointestinal blood perfusion assessment during the procedure.

Importance of splenectomy in the operative treatment of gastric cancer

The value of simultaneous splenectomy as part of an oncologically adequate resection for gastric cancer has been controversially discussed over the last decades. As part of aprospective multicenter observational study data were obtained from patients admitted to hospital with histologically diagnosed primary gastric cancer or adenocarcinoma of the esophagogastric junction (AEG). The profiles of care of patients who had undergone surgical treatment in 141 surgical departments from 1 January 2007 to 31 December 2009 were collated. Overall, 2897 patients were enrolled in the study (tumor resection, n = 2545). The overall splenectomy rate was 11.1% (n = 283) and the highest proportion was found in AEG tumor lesions (19.4%). In the whole group of patients as well as depending on the tumor site, there was ahigher preoperative comorbidity in splenectomized patients. While the rate of general postoperative complications after splenectomy was significantly increased in all patients and also depending on various tumor sites, there were no differences in the rate of specific postoperative complications. Asignificantly higher hospital mortality comparing the splenectomy group of patients with those in whom the spleen could be preserved, was only observed in AEG-associated tumor lesions (15.2% vs. 5.0%). All splenectomized patients showed ashorter long-term survival (p < 0.001) compared to resections with a preserved spleen (18 months vs. 36months). In the surgical treatment of gastric cancer, splenectomy can be considered anegative predictor for aworse perioperative outcome and aworse long-term survival.

Treatment of gastric adenocarcinoma at a New Zealand centre: meeting the challenges of a low volume country.

Surgical treatment of gastric cancer in New Zealand is challenging because of a low annual incidence of 400 patients and population dispersal over a wide area with little data on regional treatment trends and outcomes. This investigation was undertaken to evaluate the surgical outcomes of gastric cancer patients presenting to a single upper gastrointestinal centre (WDHB, Waitemata District Health Board) and to compare these to national and international standards. Data on 135 patients with histologically proven gastric adenocarcinoma presenting between January 2010 and December 2014 were reviewed and compared with nationally available procedural volume data. Sixty of 135 patients were resected (resection rate 44%) and 75 patients were managed with palliative chemotherapy/symptomatic care alone. Twenty-six patients (43%) received adjuvant or neoadjuvant chemotherapy and only two patients (3%) underwent laparoscopic resection. In resected patients, 90-day mortality was 1.6%, and 11 patients (18%) developed complications ≥ Clavien-Dindo grade 3. Fifty-two patients (87%) had ≥15 lymph nodes resected and 54 patients (90%) had a histological R0 resection. At median follow-up of 49 months, 30 patients remain alive and disease-free with 20 true 5-year disease-free survivors. National data between 2010 and 2014 showed WDHB performed 20% (338/1710) of gastric resections for all indications in New Zealand. While WDHB is an internationally low volume centre for gastric cancer, surgical outcomes benchmark satisfactorily to international standards. New Zealand's national treatment standards should set aspirational goals for gastric cancer treatment and have a clear strategy to address issues of surgical volume and national service provision.

Brief discussion on prevention of the secondary damage in the procedures of D2 lymphadenectomy for gastric cancer

So far, D2 lymphadenectomy has been recognized as the key one of the procedures in curative resection for gastric cancer. In summary, the standardized implementation of D2 lymphadenectomy can contribute to both surgical quality and patients' prognosis. Lymph node dissection, as an important basis for local surgical treatment of gastric cancer, involves certain technical risks due to complex adjacent relationship and anatomical variation of organs or blood vessels, and so on. There is a certain incidence of side injuries in D2 lymphadenectomy for a surgeon, regardless of the experience of learning curve. Complying with specification of surgical procedures and summarizing the vital points of lymph node dissection in each curative gastrectomy for gastric cancer is the principal method to reduce or avoid the occurrence of relevant complications after surgery.

Blast from the past: Perioperative use of the Maruyama computer program for prediction of lymph node involvement in the surgical treatment of gastric cancer following neoadjuvant chemotherapy

BackgroundSurgical quality assurance is a key element of gastric cancer treatment. The Maruyama Computer Program (MCP) allows to predict lymph node involvement in stations no. 1–16. The aim of the current study was to evaluate the accuracy of the MCP predictions in GC patients treated with neoadjuvant chemotherapy (nCTH) followed by gastrectomy with adequate lymphadenectomy. Methods101 patients who underwent preoperative nCTH followed by D2 gastrectomy with curative intent were analysed. The response to nCTH was measured using the tumour regression grade system. ResultsTest sensitivity, specificity, PPV, NPV and accuracy of the MCP were 92%, 33%, 41%, 89%, and 53%, respectively. In patients with response to nCTH, number of false positive (FP) results was significantly higher than in patients who did not respond to nCTH both in the N1 (56.3% vs 28.9%, p < 0.0001) and in the N2 (59% vs 41%, p < 0.0001) trier. The risk for FP results was 6 times higher in N1 (OR = 6.50, 95%CI: 3.91–10.82,; p < 0.0001) and N2 (OR = 5.84, 95%CI: 2.85–11.96; p < 0.0001) triers. In patients with intestinal type GC, the risk for FP results was 4 times higher than in other histologic types of GC in both N1 (OR = 4.23, 95%CI: 2.58–6.95; p < 0.0001) and N2 (OR = 4.23, 95%CI: 2.02–9.62; p = 0.0002) triers. ConclusionsMCP predictions in the GC patients treated with nCTH have low specificity due to significantly high number of FP results. Noticeably low accuracy level of predictions indicate a need for new prediction models, based on Laurén classification, since it may provide some information on expected regression grade.

Effects of Sarcopenia on Early Postoperative Outcomes in Patients Undergoing Surgical Treatment for Gastric Cancer

Effects of Sarcopenia on Early Postoperative Outcomes in Patients Undergoing Surgical Treatment for Gastric Cancer

Hemi-double stapling technique performed with a transorally inserted anvil for esophagojejunostomy in the surgical treatment of gastric cancer.

A transorally inserted anvil has been developed to facilitate the creation of a stapled anastomosis without the need for a purse string to secure the anvil into place during laparoscopic total gastrectomy (LTG). We describe a hemi-double stapling technique and application of a transorally inserted anvil for esophagojejunostomy during LTG, and we report the results of a retrospective study in which we examined the feasibility and safety of this method. We also describe the key technical details of the method. Our anastomotic method has four chief features: (a) the esophagus is cut at a slant, and its left cut end is cut and punched for the hemi-double stapling technique; (b) the anvil and circular stapler are connected, placing the distal jejunum in cranial traction; (c) a single layer of sutures is used to correct dog-earing and overlapping, and these points are completely closed with Lembert sutures; and (d) the jejunal limb is fixed to the duodenal stump to prevent kinking of the jejunal limb and to decrease tension on the anastomosis. This method has been used in 53 patients thus far. LTG with Roux-en-Y reconstruction was successful in all patients, and there was no need for conversion to open surgery. The mean operative time was 313 minutes, and the mean blood loss was 106 mL. The mean postoperative hospital stay was 18 days. There was no anastomotic leakage or stenosis. Hemi-double stapling technique with a transorally inserted anvil for LTG can be performed safely and easily and safely. It can also product good outcomes.

Laparoscopic Surgery for Gastric Cancer: The European Point of View.

Objective Multiple Asian studies have proved the feasibility of laparoscopic approach for surgical treatment of gastric cancer. The difference between Asian and European patients could limit their application in Europe. We reviewed the literature for European studies comparing open gastrectomy with laparoscopic approach in the treatment of gastric cancer. Method We searched the keywords gastric cancer and laparoscopy in MEDLINE and EMBASE. We included all studies published between 1990 and 2016 and conducted in Europe. Result We found 1 randomized and 13 cohort studies which compared laparoscopic with open gastrectomy. We found no mean difference in the number of lymph nodes harvested between laparoscopic and open group (mean difference: -0.49; 95% CI: -2.42; 1.44, p=0.62) and no difference of short-term or long-term mortality (short-term odds ratio: 0.74, p=0.47; long-term odds ratio: 0.65, p=0.11). We found a longer operative time in the laparoscopic group (mean difference: 35.75 minutes, p<0.01) but lesser reoperation rate than the open group (odds ratio: 1.55 p=0.01). Conclusion European based population studies found results comparable with their Asian counterpart. In the current state of evidence, minimally invasive surgery for gastric cancer is safe and can achieve the same oncological results.

The Precised Management of Surgical Treatment for Gastric Cancer: Interpretation of the 5th edition of Japanese Gastric Cancer Treatment Guideline and the 15th edition of Japanese Classification for Gastric Cancer

The 8(th) UICC gastric cancer TNM classification has international view since it was based on the follow-up data from 57 institutes of 15 countries. The number of examined lymph nodes is a determining factor for accurate staging. Dissection of No13 and No14 nodes may benefit for the selected distal advanced gastric cancer. The concept of esophagogastric junction cancer was redefined and Siewert type Ⅲ EGJ cancer will be classified according to the TNM staging of gastric cancer. The transhiatal approach has survival advantage for patient with esophageal invasion of 3 cm or less EGJ cancer. The dissection of distal lymph nodes for patients with 4 cm or less EGJ cancer is not recommended and the clinical benefit of dissection of lymph nodes in mediastinum is not clear. No10 node dissection is not recommended to the D2 procedure for total gastrectomy. Bursectormy could not bring survival benefits for cT3/4 gastric cancer, nor could palliative surgery bring improved survival to patients with metastatic gastric cancer. However, for highly selected cases of stage Ⅳ gastric cancer, conversion therapy can make some patients get the opportunity of radical operation and gain the chance for long-term survival.

Herbal Medicine for Dumping Syndrome: A Systematic Review and Meta-Analysis.

Background: Dumping syndrome is a common complication of surgical treatment of gastric cancer, but conventional therapy has limitations related to symptom care due to its structural cause and the decreased quality of life. Objectives: The objective of this review was to assess the clinical evidence for the effectiveness of herbal medicine as a treatment for dumping syndrome. Methods: A literature review was conducted using 16 databases from their inceptions to March 2018. All randomized controlled trials (RCTs) of herbal medicine used to treat dumping syndrome patients were included and meta-analyzed. Methodological quality was assessed using the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 174 dumping syndrome patients of 3 trials met all inclusion criteria. Two trials assessed the effectiveness of herbal medicine on the symptom response rate compared with conventional pharmacotherapy. Their results suggested significant effects in favor of herbal medicine (risk ratio [RR] = 1.37, 95% confidence interval [CI] = 1.16-1.63, P = .0003, heterogeneity τ2 = 0, χ2 = 0.02, P = .88, I2 = 0%). One trial assessed its effectiveness on the improvement rate of overall symptoms compared with conventional conservative complex therapy, such as postural management, diet regulation, and counseling (RR = 1.23, 95% CI = 0.96-1.58). Conclusions: Due to the small sample size, scarcity of reported articles, and lack of quality of the current RCTs, it was concluded that the effectiveness of herbal medicine in treating dumping syndrome is unclear.

THE COMPARATIVE ASPECTS OF TWO MODIFICATIONS OF GASTRIC RESECTION ACCORDING T. BILLROTH TECHNIQUE IN ONCOLOGIC PRACTICE

The surgical intervention implying total ablation of tumor, continues to be the only method giving hope for recovery of patient despite a significant number of combined and complex methods of treatment of the given disease. However, many positions of the given conception underwent cardinal changes. Nowadays, most of authors recommend after gastric resection to restore to the extent possible natural anatomic relationships that provides best functional results. At the same time, certain researchers give preference to Billroth-II mode and at that some of them are devoted opponents of gastric resection by Billroth-I mode in case of cancer. This opinion is based on supposition that gastric resection by Billroth-II mode provides in greater extent radicalism in case of treatment of malignant neoplasms of given localization. The main factor restraining application of this most physiological operation is established opinion alleging its oncologic non-efficacy. The thesis is substantiated that intervention into modification of operation according Billroth method does not result in increasing of number of post-operative complications and that there is no differences also in distant results of surgical treatment of gastric cancer in case of application of both modes of restoration of continuity of digestive tract after sub-total distal resection. At the same time, quality of life of patients becomes better after reconstruction of digestive tract using gastroduodenal anastomosis. Most of researchers, studying indications to sub-total gastric resection using method Billroth-I, assume that it is reasonable to apply this particular mode of restoration of continuity of gastrointestinal tract only in case of early cancer, its exophytic forms (stage I and II) located in area of stomach angle or its low one third of its body and absence of metastases into regional lymphatic nodes.