SURGICAL TACTICS IN COMPLICATED FORMS OF GASTRIC MALIGNANT TUMORS

Abstract

Summary. Introduction. Malignant neoplasms of the stomach are of the most common oncological processes, showing a relatively high mortality. The number of complications of the gastric malignant tumours (MT) remains high, despite the improvement of diagnostic and treatment tactics. Aim. To analyse the structure of complications of gastric MT’s and to evaluate the efficacy of the modern surgical tactics in their treatment. Materials and methods. The study is based on the evaluation of the results of treatment of 84 patients with complications of gastric MT’s in compliance with international and national ethical standards. The average age of the patients was (57.3±8.72) years, men dominated (P<0.001) (77.4 %). The Charlson comorbidity index value is 5.78 (unadjusted for age) and 7.14 (adjusted for age). The diagnosis of gastric MT was verified morphologically; the diagnosis of complications was based on the relevant recommendations. Results. The structure of gastric MT’s complications was represented by perforations, which were observed in 42 patients (50.0 %), acute gastrointestinal bleeding in 23 patients (27.3 %), gastric stenosis of various degrees in 18 patients (21.4 %). In one case of sarcoma of the body of the stomach, intraoperatively a rare case of complication of gastric MT was diagnosed, a giant intramural hematoma of a rounded shape 25×22 cm pseudocystic formation. Subcompensated stenosis was observed in 16 (88.9 %) patients, in the rest patients it was decompensated. Radical surgical interventions were performed in 54.8 % of patients, various types of suturing of perforations were performed in 45.2 %. According to the severity of bleeding, patients with an average degree of severity prevailed – 18 (78.3 %) patients, one patient with stage II gastric cancer had mild bleeding, and 4 (17.4 %) patients had severe gastric bleeding. Surgical tactics consisted of an individualized step-by-step approach, which showed effectiveness, mortality was not observed in this group of patients. Conclusions. The nature, volume and stages of surgical intervention in patients with complicated forms of malignant gastric tumours should encompass the extensiveness of the oncological process, the features of the complications, and the patient’s condition. The applied surgical tactics allow to ensure sufficient efficiency of treatment of complications of gastric MT’s. The presence of water-electrolyte, metabolic disorders requires long-term and more extensive preoperative preparation.