P-0081 - Results of gastropancreatosplenectomy at locally advanced gastric cancer
|Date||28 June 2014|
|Event||World GI 2014|
|Topics|| Gastric Cancer
Surgery and/or Radiotherapy of Cancer
|Citation||Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165|
S. Khudayorov1, H. Tuyev2
To improve the results of surgical treatment of locally advanced gastric cancer by applying of extended combined operations.
In the department of Abdominal Surgery, National Research Center of Oncology during the period from 2005 to 2013 years to 178 patients with stomach cancer with invasion various parts of pancreas and gate of spleen was performed extended combined operations. Depending on extent of the operation, patients were divided into 2 groups: 1st group – n = 112 was performed extended gastropancreatosplenectomy; 2nd group – n = 66 was performed extended gastrectomy with a plane resection of invade sites of pancreas. In both groups performed D2 dissection, and in the 1st group was performed splenectomy with lymph dissection of 10th group lymph nodes. Indications for gastropancreatosplenectomy were deeper tumor invasion in pancreatic parenchyma and infiltration of the splenic artery, also localization of invaded area left site of upper mesenteric artery and vein. The indications for resection plane were shallow invasion in local areas up to 3 cm, without infiltration of the splenic artery, as well as localization of invaded area of the right site of upper mesenteric artery and vein. Histological examination of more than 88% of cases detected low differentiated adenocarcinoma and 12% of cases, moderately differentiated and highly differentiated adenocarcinoma. In 1st group 102 (91.1%) patients executed hemipancreatectomy, in 10 (8.9%) cases distal subtotal resection and in 2 cases resection of tail and partially pancreatic body. In 2nd group all patient made plane resection and 22 (33.3%) cases the bed was subjected by cryoablation.
Postoperative complications were 15.2% (17 patients) in 1st group. Among them prevailed exudative pleuritis in 9 patients, pancreatic stump fistula in 2 patients and pancreatitis in 3 patients, lymphorrhea - 1 and prolonged hemorrhagic discharge in 1 patient, acute cardiovascular collapse - 1. 1 patient died from myocardial infarction. In 2 group postoperative complications was 13.6% (9 patients). Character of complications: pleuritis in 5 patients, pancreatitis in 3 and with long lymphorrhea 1 patient. Lethal outcomes weren't in both groups. 3 year survival rate in 1 group was 36.2 + 0.33%, in the 2nd group 30.3 + 0.4%. 5-year survival rate, respectively, 26.2 + 0.4% and 19.1 + 0.3%. Metastasis in both groups was almost identical. Recurrence of pancreatic stump in 1 group was 10.7% of patients and in 2 group 28.2%.
In gastric cancer with invasion into the pancreas more radical and perspective is gastropancreatosplenectomy, which in comparison with a plane resection, significantly reduce the incidence of recurrence and improves the 3 and 5-year survival.