[Character of surgical interventions in patients with stomach cancer in non-oncologic institutions].
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Biomedical subjects
Publications and source records attributed to B A Boliukh.
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In 395 patients with gastric cancer, the subtotal distal resection of the stomach was performed at the oncologic dispensary. In 47.6% of cases, a blunder in ablasticity of operation was committed. Distal resection of the stomach was unreasonably performed in patients with involvement of the middle gastric portion and in infiltrative tumour growth.
The results of performance of exploratory laparotomy in 333 patients with gastric cancer have been analysed. The main reason of the use of laparotomy consists in seldom use of the special methods for diagnosis of tumor spreading. Complex use of laparoscopy and radionuclide methods for diagnosis permits to reduce the number of unsubstantiated laparotomies by 45-50% and bring down the frequency of its performance to 12-15% of the total number of operative interventions in gastric cancer.
Refusal of treatment was analysed in gastric cancer patients registered in the whole region (12.9%) and in the oncologic dispensary (12.1%). Two hundred and two patients refused treatment, 43 of them agreed to be operated 2 or more months later. Fewer refusals were registered among male and adult patients. The number of refusals increased with age. Reason for refusal were analysed. Explanatory work was carried out and some of them were informed of their diagnosis. Patients were invited for repeated explanation. Low level of medical education of the population, particularly, in the field of oncology was shown to be the main reason to refuse surgery.
The methods for diagnosis of gastric cancer in 711 patients who were not hospitalized because of age and tumor dissemination have been analysed. The roentgenologic, endoscopic, morphologic and radionuclide methods of investigation in these patients were used less frequently than in patients treated in a hospital. The examination, being not thorough, didn't permit to establish the correct diagnosis and choose an adequate method for treatment.
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Results of treatment of 571 patients with gastric cancer as well as errors committed during palliative and radical surgery were analysed. General surgeons not infrequently performed distal resection of the stomach for cancer of its proximal part whereas in cases of gastrectomy the distal part of the esophagus was not removed when indicated. On the contrary, in patients with cancer of the distal part of the stomach, surgeons aspired to save as much of the organ as possible, as would be done for the treatment of gastric ulcer. Principles of radical surgery for cancer were violated in those cases.
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