Makroskopischer Aufbau des Magens. Dieser Eingriff ist bei sehr hohem Tumorsitz im Bereich der Cardia erforderlich. Das Operationsfeld wird durch ein so genanntes Retraktorsystem offen gehalten. Am gemeinsamen Ursprung dieser Arterien Truncus coeliacus wird das Lymphgewebe bis zur Bauchschlagader entfernt. Bevorzugt wird wegen seiner guten Beweglichkeit das Jejunum verwendet.
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This article has been cited by other articles in PMC. Abstract Objective To evaluate the impact of subtotal SG versus total TG gastrectomy on the oncologic outcome of patients with cancer of the distal stomach from 28 Italian institutions. Summary Background Data There is controversy over whether SG and TG have a different impact on the 5-year survival probability of patients with cancer of the distal half of the stomach.
Methods The present analysis involved patients randomized during surgery to SG or TG , provided there was at least 6 cm from the proximal edge of the tumor to the cardia, there was no intraperitoneal or distant spread, and it was possible to remove the tumor entirely. Both surgical treatments included regional lymphadenectomy.
Median follow-up was 72 months after SG range 2 to and 75 months after TG range 7 to Five-year survival probability as computed by the Kaplan-Meier method was The test of equivalence led to the conclusion that the two procedures may be considered equivalent in terms of 5-year survival probability.
The analysis of survival using a multivariate Cox regression model showed a statistically significant impact on survival of tumor site, tumor spread within the gastric wall, extent of resection to the spleen plus or minus neighboring organs or structures, and relative frequency of metastasis in resected lymph nodes.
Conclusions Both procedures have a similar survival probability. The authors believe that SG, which has been reported to be associated with a better nutritional status and quality of life, should be the procedure of choice, provided that the proximal margin of the resection falls in healthy tissue.
Cancer of the stomach is the second most common cancer in the world. In the same period, deaths attributable to stomach cancer were estimated at ,, or The latter figure is slightly higher than that reported in a previous study. However, the power of the study was weakened because fewer patients participated in it than was planned in the statistical design. Further, the two treatments were merely compared, without allowance being made in the analysis for the possible effect of important prognostic variables e.
The present study reports the results of a multicenter randomized Italian trial that investigated the effects of SG and TG in patients with cancer of the distal half of the stomach.
It focused in particular on 5-year survival probability and the impact of certain prognostic factors on the oncologic outcome. METHODS Patients Between April and December , patients from 31 Italian institutions were screened for participation in a multicenter prospective controlled clinical trial to compare potentially curative SG and TG in patients with cancer of the distal half of the stomach.
Details on eligibility criteria, surgical techniques, randomization, accrual, and follow-up modalities have been reported in a previous study. Before surgery, patients were considered candidates if they had a cancer of the distal half of the stomach without apparent distant metastases, were no older than 75, were in relatively good condition, and had no history of previous cancer, gastric resection, or cytotoxic chemotherapy. Patients judged to be eligible at laparotomy were randomly allocated to SG or TG groups using an ordered set of sealed envelopes containing the indication of the treatment assigned according to a computer-generated random permuted blocks list.
Before the patient was discharged, all information concerning eligibility criteria was sent to the coordinating center on a standard form. Regardless of the type of operation performed SG or TG , an effort was made to maintain a distance of at least 6 cm from the proximal edge of the tumor to the line of the anastomosis, thus minimizing the risk of leaving residual neoplastic deposits in the stomach or esophagus.
Finally, 13 patients 8 SG and 5 TG had a distal margin infiltrated by the tumor. One patient from the SG group had both proximal and distal margins involved. Ten patients four SG and six TG received postoperative adjuvant chemotherapy. A technique of D2 gastrectomy, as described by Nakajima and Kajitani, 23 was recommended, as follows.
The entire greater omentum, superior leaf of the mesocolon, pancreatic capsule, and lesser omentum were removed en bloc with the stomach. The left gastric artery was ligated at its origin. Lymphadenectomy included dissection of node levels 1 and 2. For all tumors, lymph nodes were removed along the lesser and greater curvature; suprapyloric and infrapyloric and right paracardial lymph nodes, and those along the left gastric artery, the common hepatic artery, and the celiac axis, were also removed.
For tumors involving the middle third of the stomach, the resection was planned to include the left paracardial lymph nodes and those along the splenic artery and the hilum of the spleen standard procedure. Splenectomy was an optional procedure left to the preference of the surgeon. The tumor was finally staged according to the recent TNM classification. Twenty-six of the randomized patients, accrued by three centers, were excluded by the monitoring committee because the information concerning baseline and follow-up visits was considered unreliable.
Thus, the final evaluable set included patients from 28 centers, randomized to SG and to TG. Open in a separate window Figure 1. The evaluable set includes patients with reliable information on baseline and follow-up visits. The study was approved by the Ethical Committee of the Istituto Nazionale Tumori, Milan, and all the eligible patients gave their signed consent to it.
The present study focuses on the primary end point of the trial—death from all causes, including postoperative deaths, which accounted for four SG and seven TG patients. To perform this analysis, the four SG patients lost to follow-up immediately after discharge were excluded, resulting in a set of subjects. The TG group also included four patients who had originally been randomized to TG but subsequently underwent SG because of intraoperative complications.
These patients had healthy proximal and distal margins of transection. The two surgical groups had similar demographic characteristics Table 1.
Traitement du cancer de l’estomac
Deze omvatten een maagperforatie , een maagbloeding , een gastritis maagslijmvliesontsteking , maagpoliepen goedaardige gezwellen op het maagslijmvlies of andere gezwellen in de maag, maagkanker en ernstige maagzweren of darmzweren. Tevens bestaat een soort verwijdering van de maag sleeve gastrectomie die handig is voor de behandeling van levensbedreigende obesitas. Deze operatie, ook gekend als een gastric bypass operatie, is echter enkel mogelijk wanneer andere opties gefaald hebben. Minder invasieve behandelingen omvatten namelijk een dieet, lichamelijke activiteiten, geneesmiddelen en begeleiding of therapie. Opnieuw beginnen roken mag overigens ook niet meteen na de operatie maar pas enkele weken later.
Gastrectomie: Chirurgische verwijdering van de maag
This article has been cited by other articles in PMC. Abstract Objective To evaluate the impact of subtotal SG versus total TG gastrectomy on the oncologic outcome of patients with cancer of the distal stomach from 28 Italian institutions. Summary Background Data There is controversy over whether SG and TG have a different impact on the 5-year survival probability of patients with cancer of the distal half of the stomach. Methods The present analysis involved patients randomized during surgery to SG or TG , provided there was at least 6 cm from the proximal edge of the tumor to the cardia, there was no intraperitoneal or distant spread, and it was possible to remove the tumor entirely. Both surgical treatments included regional lymphadenectomy.