PubMed · 14432332
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B A PETROV, I V DANILOV. [Sternal section for gastrectomy].. https://pubmed.ncbi.nlm.nih.gov/14432332/
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We present a case of early gastric cancer located in gastric volvulus associated with paraesophageal hiatal hernia. Two lesions of EGC were diagnosed in the distal third of the stomach, most of which had herniated into the left chest through a large hiatal defect in an organoaxial fashion. Routinely, laparoscopic-assisted distal gastrectomy (LADG) is our preferred approach for EGC, and the presence of hiatal hernia in this case did not alter our approach. Laparoscopic repair of hiatal hernia was performed successfully followed by LADG. A review of the literature supports a minimally invasive approach for both procedures and shows it to be safe, effective, and technically feasible. Further, LADG is shown to be oncologically adequate in terms of tumor margins and lymph node dissection, but its relevance to long-term disease-free survival still needs to be studied in well-designed prospective trials.
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The aim of surgical treatment is complete resection (Ro-resection) of the tumor in all dimensions of its growth, i.e. resection of the tumor infiltrated stomach including the locoregional lymph nodes. This can be achieved by stage- or histology adapted surgery resulting in subtotal distal and total gastrectomy as complementary procedures. Local excision of gastric carcinoma in curative intent is indicated only in mucosal carcinoma of the intestinal type. The extent of lymph node dissection is still under discussion; the results depend on the experiences of the surgeon. Several studies have shown a prognostic improvement after systematic (D2) lymphadenectomy in stage II/IIIA-disease or in patients with a low incidence of lymph node metastases. Pancreas preserving splenectomy is suggested in tumors of the proximal stomach or after direct infiltration of these organs. The Roux-en-Y procedure represents the most commonly used method of reconstruction after subtotal distal or total gastrectomy. The importance of the duodenal passage as well as of the pouch construction must be investigated in prospective studies in the future. This is true for the value of perioperative multimodal treatment options.