Radical gastrectomy with D2 lymph node dissection after neoadjuvant therapy.

OBJECTIVES: This study focuses on the evaluation of the effectiveness of radical gastrectomy with D2 node dissection after neoadjuvant therapy in the patients with gastric cancer. Gastric cancer is a widespread type of cancer, and it is the third leading cause of death in the cancer patients. Metastases most often occur in the lymph nodes and therefore, in addition to gastrectomy, lymph node dissection is often performed in the patients. We are distinguishing between D1, 2 and 3 dissections. As with other cancers, the effectiveness of neoadjuvant therapy is being considered, which aims to improve the patient's prognosis and thus the 5-year survival rate. METHODS: Within the study, we evaluated a group of the patients diagnosed with gastric cancer (n = 41). The average age of the patients was 62.3 years (20-72 years). 68.3 % (n = 28) patients underwent neoadjuvant therapy before surgery, the remaining 31.7 % (n = 13) underwent only radical gastrectomy with D2 lymphadenectomy. In all the cases, an open operational approach was implemented. CONCLUSION: Lymphadenopathy was found in 85.4 % of the patients. Complications occurred in both groups, but in the group with neoadjuvant therapy their share was lower (14.3 % vs 23.1 %), while in the group without neoadjuvant treatment the proportion of duodenal leaks was higher, as well as the number of reoperations. In total, an average of 30 ± 8 lymph nodes were harvested. A lower number of T3-4 cases was found in the neoadjuvant group (17.9 % vs 61.6 %), confirming that the tumour size was significantly smaller in the neoadjuvant group than in the group, who did not undergo it and underwent only surgical treatment. Relapse was found in 29.3 % of the patients after neoadjuvant treatment and in 38.5 % of the patients without neoadjuvant treatment. Also, mortality due to relapse was higher in the group without neoadjuvant treatment (30.8 % vs 21.7 %). The average survival was 25 months (Tab. 3, Fig. 3, Ref. 60).

Coincidence of splenic vein aneurysm and haemorrhagic cyst of the pancreas.

Pseudoaneurysm of the splenic vein is a rare entity which is associated with pancreatitis in 52 % cases. Pseudocysts of the pancreas create approximately 70 % of all cystic lesions of the pancreas. One of the most dangerous complications of pancreatic pseudocysts is bleeding into the cystic lumen. This is caused by perforation of the pseudoaneurysm of the splenic vein. Enzymatic damage of the splenic vein´s wall is the cause of pseudoaneurysm. The clinical condition varies. It can be asymptomatic or bring about haemodynamic instability. The diagnostic process of pseudoaneurysm of the splenic vein is difficult. This case study introduces a case of a 50­year­old man with the anamnesis of recurrent pancreatitis caused by alcoholism. He had abdominal pain and was diagnosed with a pseudocyst of the pancreas. Abdominal CT showed an extensive capsulated collection in the left subphrenic space, 23cm in diameter, with serosanguineous content and coagulations. The CT visualised the mass effect on the surrounding tissues and a complete deformation of the spleen. Between the collection and partially oppressed tail of the pancreas there was a venous pseudoaneurysm, 3.5cm in diameter. Considering its localization, it most probably originated from the splenic vein. Surgery was done. We did distal resection of the pancreas with a complete removal of the pseudocyst and spleen (Fig. 7, Ref. 11). Keywords: splenic vein, pseudoaneurysm, pancreatitis, pancreatic pseudocysts.