Surgical treatment of malignant tumors of the cardiac part of the stomach, complicated by bleeding, perforation and stenosis

Abstract

The aim of the work is improving the results of surgical treatment of malignant tumors localized in the cardiac part of the stomach, complicated by bleeding, perforation and stenosis. In the Kyiv City Center for providing assistance to patients with acute gastrointestinal bleeding on the basis of the "Kyiv City Clinical Hospital No.12" from 2006 to 2020, 766 patients with malignant tumors of the stomach, which were complicated by bleeding, perforation or stenosis, were treated. Including, 292 patients had a tumor localized in the cardiac part of the stomach, including with a transition to the esophagus – in 30 (10.3%), 10 (33.3%) of these patients had stenosis phenomena). The tumor was complicated by bleeding in 285 (97.6%) patients, in 10 (3.5%) by bleeding and stenosis, in 7 (2.4%) by perforation of the tumor, in 2 by perforation and bleeding. Operative treatment was performed in 138 (47.3%) patients out of 292. At the same time, radical operations were performed in 94 (68.1%) patients, 1 (1.1%) of them due to tumor perforation. Palliative and symptomatic operations were performed in 44 (31.9%) patients. Among them, 2 (4.5%) patients were operated on for perforation, 2 (4.5%) for a combination of perforation and bleeding.8 (5.6%) patients underwent emergency surgery at the height of ongoing bleeding and at the height of its recurrence, including 4 (50.0%) radically, 4 (50.0%) non-radically. Of them, 5 (62.5%) also had perforation of the tumor. In the early delayed period (ERP), after adequate preparation and comprehensive follow-up examination, operative treatment was performed in 130 (94.2%) patients, 92 (70.7%) underwent radical surgery, 38 (29.2%) underwent non-radical surgery. The total postoperative mortality was 6.5% (12 patients), while the specific weight of mortality after non-radical surgical interventions was 4.6 times higher in comparison with the mortality rate after radical operations. It is established thatthe specific weight of deaths after radical surgical interventions was 2.2 times lower compared to palliative and symptomatic surgeries. The frequency of performing lymphodissection in volume D2 was higher in 2.8times after radical operations performed in the RVP and amounted to 71.8%. In the case of perforations of malignant tumors, 80.0% were non-radical surgical interventions.

Keywords: radical operations, gastrectomy, lymphodissection.