ABSTRACT
The article considers issues of development of model of palliative care and analysis of its activities. The study was based on the results of medical care provided by palliative service of the Republic of Tatarstan. The palliative service is complex system that unites several different institutions. The palliative care is provided in hospital and out-patient settings. In the oncologic hospital beds are integrated to provide urgent and palliative care to patients with cancer to apply comprehensive complex of medical interventions. Out-patient care is provided by 7 field teams including oncologist (3 teams) and two paramedics (4 teams). Four field teams function day-and-night seven days a week. Since 2014, the "Children's Hospice" unit functions as element of palliative service. Since 2015, in Almetyevsk, functions field department of palliative care attached to polyclinic of oncologic dispensary/ It co0nsists of two field medical teams. The provision of palliative care is to include all stages needed: palliative care offices, outpatient services, inpatient departments and hospices. The integration of palliative care into common health care network makes it possible to apply tangible possibilities and research potential of large medical institutions and advanced technologies of modern medicine as well.
Subject(s)
Hospice Care , Neoplasms , Palliative Care , Hospitals , Humans , Neoplasms/therapy , TatarstanABSTRACT
The examination of lymph nodes of 64 preparations removed in resections of the stomach and gastrectomies associated with extensive lymphadenectomy has shown that for invasive forms of gastric cancer extensive lymphadenectomy should be fulfilled with ablation of lymph nodes adjacent to major parietal vessels: hepatic, splenic, superior mesenterial arteries, celiac trunk, aorta, inferior vena cava and portal vein.
Subject(s)
Lymph Node Excision/methods , Stomach Neoplasms/surgery , Evaluation Studies as Topic , Gastrectomy , Humans , Lymph Nodes/pathology , Lymphatic Metastasis , Neoplasm Invasiveness , Neoplasm Staging , Stomach Neoplasms/pathologyABSTRACT
When using routine methods of lymphadenectomy the excisable parietal groups of lymph nodes are left intact. This is considered to be an unjustified ground for refusal of a curative operation for gastric cancer Metastases to lymph nodes of these groups are frequently found in gastric cancer. The authors recommend to use extensive lymphadenectomy when the removed preparation includes the lymph nodes of parietal groups. It was shown that the degree of the operative risk did not increase in this case. Five year survival was achieved in certain patients having metastases to lymph nodes of parietal groups.
Subject(s)
Gastrectomy/methods , Lymph Node Excision/methods , Stomach Neoplasms/surgery , Esophageal Neoplasms/surgery , Follow-Up Studies , Humans , Lymphatic Metastasis , Pancreatic Neoplasms/surgery , Splenic Neoplasms/surgery , Time FactorsABSTRACT
Serial histological assays of lymph nodes removed during extensive lymphadenectomy not infrequently reveal metastases, in case of gastric cancer, in paraaortic lymph nodes and the nodes located along the celiac trunk, splenic and hepatic vessels. Among 35 patients 19 showed metastases in these nodes. Metastases were detected also in cases when lymphnodes of these collectors seem to be intact (in8 of 23 patients). Routine lyphadenectomy is unlikely to be considered radical. A total of 112 operations with extensive lymphadenectomy have been performed: gastrectomy (84), distal resection (12), proximal resection (13), extirpation of the gastric stump (3). Of special value is transabdominal approach associated with instrumental correction by dilators attached to an operating table (the technic suggested by M. Z. Sigal). The technic of this operation is described. A total mortality rate was 14.3%. There were no lethal complications due to lymphadenectomy. It seems rational to revise the currently used estimates of the degree of radicality of lymphadenectomy in gastric cancer.
