Oncology
doi: 10.25005/2074-0581-2018-20-4-383-388
PALLIATIVE-CURATIVE SURGICAL INTERVENTIONS IN GASTRIC CANCER PATIENTS WITH LIVER METASTASES

R.Z. Yuldoshev1, D.Z. Zikiry akhodzhaev2, M.T. Rakhmatov1, S.A. Dilshodov2, Yo.I. Az atulloev3, A.A. Khodzhamkulov2

1Department of Oncology and Radiology, Avicenna Tajik State Medical University, Dushanbe, Republic of Tajikistan
2Republican Cancer Research Center, Dushanbe, Republic of Tajikistan
3Department of Oncology, Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan, Dushanbe, Republic of Tajikistan

Objective: To assess the effectiveness of relatively curative surgical interventions in the treatment of patients with gastric cancer with metastases to the liver and to show the role of active surgical tactics in improving the quality of life of patients.

Methods: The study included 28 patients with gastric cancer with metastases to the liver. Patients with type I and type II Borrmann’s tumor growth (17 (85.7%) patients) were prevalent. It was found that in the predominant majority of patients had lesions of regional lymph nodes (91.6%). Detection of ultrasound and CT studies of enlarged retroperitoneal lymph nodes, lymph nodes of the aortocaval space, as well as massive invasion of the serous cover of the stomach with the extra organ component detected by laparoscopy, is a contraindication for performing simultaneous operations on the stomach and liver. In 14 (50%) patients,surgical interventions were carried out against the background of a complicated clinical course of gastric cancer: in the presence of pylorostenosis in 9 (32%) cases and torpid (sluggish) bleeding in 5 (17.85%) cases.

Results: Analyzing the primary tumour and metastatic hearth in the liver, we came to the conclusion that gastric cancer with gastric metastases in the liver should be resected in cases of highly or moderately differentiated adenocarcinoma that has exophytic or mixed forms of growth, preferably with the intactness of the serous cover of the stomach. Practically in half of the patients in our series, the metastasis in regional lymph nodes are revealed,however, only in two, the defeat of lymph nodes of the second – order was diagnosed. Thus, “resectable” liver metastases can occur even at the N0 stages. In the studied group, patients with type I and II Borrmann’s prevailed with type I and II, most of them showed the intestinal histological type of a tumour.

Conclusion: Liver resection for gastric cancer metastases should be performed under the following conditions: the absence of other distant metastases (peritoneum, non-regional lymph nodes, etc.); performing “radial” gastrectomy with D2-D3 lymphadenectomy; the possibility of carrying out macroscopic radical resection of the liver; functional portability of the operation; physiological operability.

Keywords: Gastric cancer with liver metastases, palliative operations, indications, prognosis.

Download file:

References
  1. Jemal А, Vineis P, Breu F, Torre L, Formand D. (Ed.). Atlas po onkologii (Atlas in oncology). 2 nd ed. Atlanta, Georgia: Amerikanskoe onkologicheskoe obshchestvo; 2014. 136 p.
  2. Siegel R, Ma J, Zu Z. Cancer incidence, mortality and prevalence worldwide in 2008. CA Cancer J Clin. 2014;69:9-29.
  3. Pisareva LF, Odintsova IN, Ananina ОА, Afanasyev SG, Volkov MYu, Davydov IM. Rak zheludka v Tomskoy oblasti: epidemiologicheskie aspekty [Gastric cancer in Tomsk region: epidemiology]. Sibirskiy onkologicheskiy zhurnal. 2013;6:40-3.
  4. Kharitonov МYu, Borbashev ТТ, Toygonbekov АК. Mestno-rasprostranyonnyy rak zheludka (obzor literatury) [Locally-spread gastric cancer (Literature review)]. Vestnik KRSU. 2016;16(11):154-7.
  5. Khaydarov II, Kurbonov КМ, Makhmadov FI. Khirurgicheskoe lechenie krovotochashchego raka zheludka [Surgical treatment of bleeding gastric cancer]. Vestnik Avitsenny [Avicenna Bulletin]. 2012;3:40-2.
  6. Zaridze DG. Profilaktika raka. Rukovodstvo dlya vrachey [Cancer prophylaxes. Manual for physicians]. Мoscow, RF: IMA-press; 2009. 224 p.
  7. Kaprin АD, Starinskiy VV, Petrova GV. (red.) Zlokachestvennye novoobrazovaniya v Rossii v 2016 godu [Malignant tumors in Russia in 2016]. Мoscow, RF: MNIOI im. P.А. Gertsena; 2018. 250 p
  8. Epidemiologiya i etiologiya zlokachestvennykh opukholey [Epidemiology and ethiology of malignant tumors] [Internet resource]. 2017. Rezhim dostupa: http://onko4.ru/2017/08/10/epidemiologiya-i-etiologiya-zlokachestvennyxopuxolej/ 2.3. 4.
  9. Skoropad VYu. Ratsionalnaya taktika lecheniya mestno-rasprostranyonnogo raka zheludka: mesto luchevoy terapii [Rational tactics of locallyadvanced gastric cancer: site of X-ray therapy]. Prakticheskaya onkologiya. 2009;10(1):28-35.
  10. Patyutko YuI, Pylev АL. Diagnostika i lechenie metastazov kolorektal’nogo raka v pecheni [Diagnostics and treatment in colorectal cancer with liver metastases]. Rossiyskiy meditsinskiy zhurnal. 2009;22:1505.
  11. Jiménez Fonseca P, Carmona-Bayonas A, Hernández R, Custodio A, Cano JM, Lacalle A,. et al. Lauren subtypes of advanced gastric cancer influence survival and response to chemotherapy: real-world data from the AGAMENON National Cancer Registry. British Journal of Cancer. 2017;117(6):775-82.
  12. Roman LD, Karachun АМ, Samsonov DV, Shostka КG, Bogorodskiy DYu, Pavlenko АN. Otdalyonnye rezul’taty khirurgicheskogo lecheniya bol’nykh mestno-rasprostranyonnym rakom zheludka [Long-term results of surgical treatment in the patients with locally-spread gastric cancer]. Povolzhskiy onkologicheskiy vestnik [Internet resource]. 2010. Rezhim dostupa: http://oncovestnik.ru/index.php/abdominalnaya-onkologiya/item/855- otdalennye-rezultaty-khirurgicheskogo-lecheniya-bolnykh-mestnorasprostranennym- rakom-zheludka.
  13. Nashimoto A, Yabusaki H, Matsuki A, Aizawa M. Surgical treatment for curable and incurable recurrent gastric cancer. Gan To Kagaku Ryoho. 2013;40(8):971-5.
  14. Chayka АV, Khomyakov VM, Vashakmadze LA, Cheremisov VV, Ryabov AB. Opyt khirurgicheskogo lecheniya retsidivov raka zheludka [The experience of surgical treatment of the recurrence of gastric cancer]. Sibirskiy onkologicheskiy zhurnal. 2015;4:12-6.
  15. Sukonko ОG. (red.) Rukovodstvo po onkologii [Manual in oncology]. Т. 2. Kn. 1. Мinsk, Belarus: Belarus Entsikl; 2016. 632 p.
  16. Stilidi IS, Nered SN. Sovremennye predstavleniya ob osnovnykh printsipakh khirurgicheskogo lecheniya mestno-rasprostranyonnogo raka zheludka [Modern representations about main principles of surgical treatment of locally-spread gastric cancer]. Prakticheskaya onkologiya. 2009;10(1):20-7.
  17. Ena II, Shanazarov NА. Sovremennye podkhody k khirurgicheskomu lecheniyu raka [Modern approaches to surgical treatment of gastric cancer]. Fundamental’nye issledovaniya. 2011;10(1):204-11.
  18. Akhmedov SМ, Safarov BD, Saidmurodov AS, Tabarov ZV. Obshirnye rezektsii pecheni pri mestno-rasprostranyonnom rake [Extensive liver resections in locally-spread cancer]. Vestnik Avitsenny [Avicenna Bulletin]. 2014;2:30-5.

Authors' information:

Yuldoshev Ravshan Zokhidovich,
Doctor of Medical Sciences, Head of the Department of Oncology and Radiology, Avicenna Tajik State Medical University

Zikiryakhodzhaev Dilshod Zukirovich,
Doctor of Medical Sciences, Full Professor, Chief Consultant of Surgical Departments, Republican Cancer Research Center

Rakhmatov Mukhammad Temurovich,
Candidate of Medical Sciences, Associate Professor of the Department of Oncology and Radiology, Avicenna Tajik State Medical University

Dilshodov Sukhrob Akhmedovich,
Cancer Surgeon of the Thoraco- Abdominal Department, Republican Cancer Research Center

Azatulloev Yodgor Imomrizoevich,
Assistant of the Department of Oncology, Institute of Postgraduate Education in Healthcare of the Republic of Tajikistan

Khodzhamkulov Ashurali Akramovich,
Head of the Thoraco-Abdominal Department, Republican Cancer Research Center

Conflicts of interest: No conflict

Address for correspondence:

Yuldoshev Ravshan Zokhidovich

Doctor of Medical Sciences, Head of the Department of Oncology and Radiology, Avicenna Tajik State Medical University

734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139

Tel.: +992 (918) 679399

E-mail: uravshan@mail.ru

Materials on the topic:
  1. MODERN VIEW ON REHABILITATION OF CANCER PATIENTS
  2. COMPLEX DIAGNOSIS OF CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE REPUBLIC OF TAJIKISTAN
  3. MODERN METHODS OF LOCAL TREATMENT OF PATIENTS WITH UVEAL MELANOMA WITH LIVER METASTASES
  4. FIRST RESULTS OF TREATMENT OF CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE REPUBLIC OF TAJIKISTAN
  5. INFLUENCE OF PLASTIC AND RECONSTRUCTIVE SURGERY ON THE QUALITY OF LIFE OF PATIENTS WITH LOCALLY ADVANCED HEAD AND NECK CANCER
  6. OUR EXPERIENCE OF IMMUNOHISTOCHEMICAL ASSAY IN BREAST CANCER
  7. EXPERIENCE OF MULTIVISCERAL RESECTIONS IN LOCALLY ADVANCED AND PRIMARY-MULTIPLE RECTAL CANCER
  8. COMBINED TREATMENT OF PATIENTS WITH NON-SMALL CELL LUNG CANCER WITH PERSONALIZED PRESCRIPTION OF ADJUVANT CHEMOTHERAPY
  9. MULTIMODAL APPROACH TO THE TREATMENT OF ESOPHAGEAL CANCER
  10. ETHNIC PECULIARITIES OF DISTRIBUTION OF ACUTE MYELOBLASTIC LEUKAEMIA IN CHILDREN’S POPULATION IN KYRGYZSTAN

◄ Back to the list