A cura di: Dr. Stefano Olmi stefano. Figura 3: Differenza di spessore della parete gastrica In condizioni di media estensioni e nel paziente normotipo il viscere ha una lunghezza di cm ed un diametro trasverso variabile da 10 a 5 cm, che decresce dalle porzioni prossimali a quelle distali. Come ogni organo, presenta una peculiare vascolarizzazione, i cui rami principali sono rappresentati dai vasi gastrici di sinistra e di destra, dai vasi gastro-epiploici e dai vasi gastrici brevi. Disturbi della digestione, come senso di peso post-prandiale sino al vomito possono rappresentare sintomi di iniziale insorgenza spesso sottovalutati.
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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.
Cirugía para el cáncer de estómago
Indications[ edit ] Gastrectomies are performed to treat stomach cancer and perforations of the stomach wall. In severe duodenal ulcers it may be necessary to remove the lower portion of the stomach called the pylorus and the upper portion of the small intestine called the duodenum. If there is a sufficient portion of the upper duodenum remaining a Billroth I procedure is performed, where the remaining portion of the stomach is reattached to the duodenum before the bile duct and the duct of the pancreas. If the stomach cannot be reattached to the duodenum a Billroth II is performed, where the remaining portion of the duodenum is sealed off, a hole is cut into the next section of the small intestine called the jejunum and the stomach is reattached at this hole. As the pylorus is used to grind food and slowly release the food into the small intestine, removal of the pylorus can cause food to move into the small intestine faster than normal, leading to gastric dumping syndrome. Post-operative effects[ edit ] The most obvious effect of the removal of the stomach is the loss of a storage place for food while it is being digested.
O tratamento consiste na remoo cirrgica total ou parcial do estmago, do omento e dos linfonodos gnglios linfticos ao seu redor. Estes linfonodos, encontrados tambm em volta das artrias que levam o sangue at o estmago, fgado e bao, podem estar tambm afetados pela doena e por isso devem tambm ser retirados linfadenectomia radical D2. A extenso de estmago que precisa ser removida depende da localizao do tumor ou da estenose. Tumores no antro normalmente so tratados com remoo parcial do estmago gastrectomia parcial ou subtotal. Os de corpo, fundo e crdia requerem a remoo completa do rgo gastrectomia total. Se houver invaso direta de outros rgos ao redor do estmago fgado, pncreas e bao, principalmente possvel retirar a parte afetada destes rgos juntamente com o estmago. Faz-se ento uma anastomose entre o que restou do estmago e o duodeno gastrectomia subtotal ou entre o esfago e o duodeno gastrectomia total.