Actual aspects of surgical treatment of the mediagastric malignant tumors, complicated by bleeding and perforation

Abstract

The aim of the work is to improve the results of surgical treatment of mediogastric malignant tumors complicated by bleeding, perforation and stenosis. During the period 2006–2020, the clinic treated 766 patients with malignant stomach tumors complicated by gastrointestinal bleeding and perforation. Malignant mediogastric tumors were diagnosed in 227 (29.6%) patients, in particular complicated by bleeding – in 212 (93.4%), perforation – in 9 (4.0%), perforation and bleeding – in 6 (2.6%) patients. In total, 106 (46.7%) among 227 patients were operated on, in particular, 13 (12.3%) patients underwent emergency surgery for tumor perforation, and in the group with newly detected cancer operative activity was 48.7% (56 out of 115). Radical operations were performed in 75 (70.8%) patients, palliative and symptomatic – in 31 (29.2%) patients. The total postoperative mortality was 6.6% (7 patients). After radical surgical interventions, 2 (1.9%) patients died, and after palliative and symptomatic operations – 5 (4.7%) (2 (40.0%) of them were operated on for tumor perforation, diffuse peritonitis). It was established that the mortality after emergency operations (22.2%) at the height of ongoing and recurrent bleeding is 4.0 times higher than after operations performed in the early delayed period (5.6%), which are performed after adequate preparation and comprehensive follow-up examination of patients. Therefore operations at the height of bleeding in patients with acutely bleeding malignant mediogastric tumors to be too dangerous, which is associated with high postoperative mortality. In the case of perforation of the tumor, it is advisable to perform palliative or symptomatic surgical interventions at the first stage in order to save the patient's life, followed by delayed (1.5–2 months) radical surgical intervention with lymphodissection D2. Keywords: malignant stomach’s tumors, endoscopic hemostasis, radical operations, palliative operations, symptomatic operations.