RECONSTRUCTION OF THE DIGESTIVE TRACT IN ADVANCED GASTRIC CANCER AFTER GASTRECTOMY WITH THE FORMATION OF AN ARTIFICIAL RESERVOIR BY HOFFMAN

The article contains the results of the first clinical experience of application of original method of surgical treatment of stomach cancer by performing a gastrectomy and formation of artificial jejunum reservoir. The relevance of the study consists in the imposition of a submerged organ of the esophageal-jejunal anastomosis hanging down the lumen of the organ, anastomosing the stump of the pancreas with the jejunum by "end-to-side" type, with a mucosal mucosa seam with a sleeve-shaped anastomosis peritoneisation and a lean jejunum loop at the level of the choledochus stump - creating anti-reflux "end-to-side" choledochojejunoanastomosis, followed by the formation of Braun anastomosis with 20 cm reservoir, by Hoffman's stomach type, performing a function of the removed stomach. The method proposed by the authors of the present study is based on more than 15years of practice in the use of refluxing anastomoses in trans-abdominal surgery and 70-year-old practice of applying diaphragm crurotomy by A.G. Savinykh, as the only method of access to the esophagus. The treatment results were assessed using X-ray contrast techniques, endoscopic and ultrasound equipment, as well as traditional laboratory, radiographic and clinical tests. The results of treatment of 6 patients in terms from 6 months to 5years were estimated. Successful outcome of the surgery was achieved in all cases. The effectiveness of the intervention is confirmed throughout the range of clinical and instrumental criteria used. The authors conclude that the method shows a good clinical perspective.

gastrectomy, anti-reflux anastomosis, stomach cancer

1. Бондарь Г.В., Думанский Ю.В., Попович А.Ю., Бондарь В.Г., Сидюк А.В. Проблемы в диагностике и хирургическом лечении рака желудка // Журнал академії медичних наук України. - 2010. - Т. 16, № 2. -С. 262-270. Bondar GV, Dumanskiy YuV, Popovich AYu, Bondar VG, Sidyuk AV. (2013). Problems in diagnostics and surgical treatment of cancer [Problemy v diagnostike i khirurgicheskom lechenii raka zheludka]. Zhurnal akademii medichnikh nauk Ukraini, 16 (2), 262-270

2. Бондарь Г.В., Думанский Ю.В., Сидюк А.В. Варианты хирургического лечения рака пищевода и рака желудка с переходом на пищевод // Международный медицинский журнал. - 2013. - № 4. - С. 57-60. Bondar GV, Dumanskiy YuV, Sidyuk AV. (2013). Variants of surgical treatment of esophageal cancer and gastric cancer with migration to the esophagus [Varianty khirurgicheskogo lecheniya raka pishchevoda i raka zheludka s perekhodom na pishchevod]. Mezhdunarodnyy meditsinskiy zhurnal, (4), 57-60.

3. Бондарь Г.В., Думанский Ю.В., Сидюк А.В. Еюногастропластика в хирургическом лечении рака желудка // Новоутворення. - 2012. - № 1-2 (9-10). - С. 65-69. Bondar GV, Dumanskiy YuV, Sidyuk AV. (2012). Jejunogastroplasty in surgical treatment of gastric cancer [Eyunogastroplastika v khirurgicheskom lechenii raka zheludka]. Novoutvorennya, 1-2 (9-10), 65-69.

4. Жерлов Г.К. Основы функциональной хирургической гастроэнтерологии. - Томск: Изд-во Томского университета, 1999. - 212 с. Zherlov GK. (1999). Principles of functional surgical gastroenterology [Osnovy funktsional'noy khirurgicheskoy gastroenterologii]. Tomsk, 2012 p.

5. Жерлов Г.К., Кошель А.П. Оперированный желудок: анатомия и функция по данным инструментальных методов исследования. - Новосибирск: Наука, 2002. - 240 с. Zherlov GK, Koshel AP. (2002). Operated gaster: anatomy and functioning according to the instrumental methods of diagnosis [Operirovannyy zheludok: anatomiya i funktsiya po dannym instrumental'nykh metodov issledovaniya]. Novosibirsk, 240 p.

6. Жерлов Г.К., Кошель А.П. Первичная и реконструктивная еюногастропластика в хирургии заболеваний желудка. - Томск: Изд-во Томского университета, 1999. - 212 с. Zherlov GK, Koshel AP. (1999). Primary and reconstructive jejunogastroplasy in the surgery of gastric diseases [Pervichnaya i rekonstruktivnaya eyunogastroplastika v khirurgii zabolevaniy zheludka]. Tomsk, 212 p.

7. Aoki M., Saka M., Morita S. (2010). Afferent loop obstruction after distal gastrectomy with Roux-en-Y reconstruction. World J Surg, 34 (10), 2389-2392.

8. Bae J., Park J.W., Yang H.K. (1998). Nutritional status of gastric cancer patients after total gastrectomy. World J Surg, 22 (3), 254-261.

9. Fujitani K., Yang H.K., Mizusawa J., Kim Y.W., Terashima M., Han S.U., Iwasaki Y., Hyung W.J., Takagane A., Park do J., Yoshikawa T., Hahn S., Nakamura K., Park C.H., Kurokawa Y., Bang Y.J., Park B.J., Sasako M., Tsujinaka T., REGATTA Study Investigators. (2016). Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA): a phase 3, randomized controlled trial. Lancet Oncol, 17 (3), 309-318.

10. Iwahashi M., Nakamori M., Nakamura M. (2009). Evaluation of double tract reconstruction after total gastrectomy in patients with gastric cancer: prospective randomized controlled trial. World J Surg, 33 (9), 1882-1888.

11. Lasithiotakis K., Antoniou S.A., Antoniou G.A., Kaklamanos I., Zoras O. (2014). Gastrectomy for stage IV gastric cancer. A systematic review and meta-analysis. Anticancer Res, 34 (5), 2079-2085.

12. National Cancer Institute. SEER cancer statistics factsheets: Esophageal cancer. Available at: http://seer.cancer.gov/statfacts/html/esoph.html (date of access 03.12.2013).

13. Noh S.H., Lee J.H., Kim K.M. (2012). Current management and future strategies of gastric cancer. Yonsei Med J, 53 (2), 248-257.

14. Noh S.H., An J.Y., Kim H.I. (2013). Pathologic and oncologic outcomes in locally advanced gastric cancer with neoadjuvant chemotherapy or chemoradiotherapy. Yonsei Med J, 54 (4), 888-894.

15. Shin D., Park S.S. (2013). Clinical importance and surgical decision-making regarding proximal resection margin for gastric cancer. World J Gastrointest Oncol, 5 (1), 4-11.

16. Siewert J.R., Stein H.J., Feith M. (2006). Adenocarcinoma of the oesophago-gastric junction. Scand J Surg, 95, 260-269.

17. Zheng Y.Z., Zhao W., Hu Y., Ding-Lin X.X., Wen J., Yang H., Liu Q.W., Luo K.J., Huang Q.Y., Chen J.Y., Fu J.H. (2015). Aggressive surgical resection does not improve survival in operable esophageal squamous cell carcinoma with N2-3 status. World J Gastroenterol, 21 (28), 8644-8652.