[Subjectivity in the estimation of findings during surgery of stomach neoplasms].
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Personal experience in the cytological diagnosis of gastric neoplasis acquired in a series of 104 patients is presented. Three false positives were detected in 29 cases of supposed malignancy and 11 false negatives in 75 patients with tumours thought to be benign. Cytology often proved the determining factor in the planning of surgery, while in some instances it also gave an indication of the histological type involved.
In 306 patients, fiberpanendoscopy and radiology were performed within a time interval of 7 days or less. In 196 cases, radiology was performed before endoscopy and in 110 cases after endoscopy. In cases with histologically unproven divergent findings, follow-up studies were performed. In the diagnosis of gastric ulcer and gastric cancer, endoscopy with biopsy was more accurate than radiology. In the diagnosis of hiatal hernia, radiology was more accurate. Important additional findings difficult or impossible to observe with endoscopy were present in 36% of the radiological examinations. Thus, the first examination should be endoscopy when ulcer or carcinoma is suspected. In patients with uncharacteristic epigastric symptoms, radiology should be performed first.
"Patient delay" in carcinoma of the stomach has been, in the past 10 years, 4 months on average. However, "doctor delay" has increased from 10 weeks to 8 months. A shortening of "doctor delay" is possible only if early endoscopy is carried out.
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Highlighted in the paper are basic treatment modalities for carcinoma of the stomach at the present stage of development of abdominal oncology, including original developments of the Ukrainean Research Institute of Oncology and Radiobiology of the Ministry of Health of Ukraine as the head institution of the country. The main index of references reflect potentialities of and prospects for treatment of gastric carcinoma over the last ten years.
Today the operative treatment of the carcinoma of the stomach is methodically mature. The prognosis is determined from the moment of the extension of the tumour. The establishment of the operability and of the tactical operative approach presumes an exact preoperative determination of the stage of the tumour using all possible diagnostic methods. While X-ray examination of the stomach and gastroscopy seize only the extension of the area of the tumour, the laparoscopy gives the possibility of an evidence of the deep growth of the tumour and metastasizing of the tumour and saves a test laparotomy for inoperable patients. A continuous interdisciplinary cooperation renders possible an immediate admission of the patient to a surgical clinic.
An analysis of surgical treatment of 100 patients with malignant tumors of the stomach with using total gastrectomy has shown that postoperative lethality made up 90%, unfavorable results of using total gastrectomy being associated with insufficient sutures of the esophageal-intestinal anastomosis. The modified method used allows to elevate reliability of the esophageal intestinal anastomosis, to shorten the time of operative procedure. Total gastrectomy followed by chemotherapy in the postoperative period prolongs the patient's life, but does not secure against recurrences of the disease in later terms.
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