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.

Conclusions: 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.

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Authors informations:

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

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

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