Surgical and combined treatment of gastric cancer--own experience.

PURPOSE: In Poland, as well as all over the world, gastric cancer is still among the leading causes of mortality and morbidity from malignant diseases. Many attempts were made to improve the results of the treatment. In this paper we present our 25-year experience in this field. MATERIAL AND METHODS: From 1977 to 2000 in the Clinical Department of Surgical Oncology, Medical University of Lódz, we treated 353 patients (males 63%; females 37%) with the diagnosis of gastric cancer, confirmed histologically. We analysed the age of patients, location of primary tumor, histologic type, stage of the disease, type of surgery, type of reconstruction of GI tract, type of adjuvant therapy and survival. RESULTS: In patients with the disease in stage I and II according to UICC Fielding classification, the best results were achieved. Five year survival reached 76% which means that early recognised gastric cancer may be cured. However, patients from this group constituted only 6.7% of all the treated population. In patients with stage III disease, 5 year survival was 34.5%. In patients with IVA stage of the disease (72 cases), in whom only cytoreductive-palliative surgery was performed, 5-year survival was 16.7%. No patient with IVB stage of the disease (purely palliative procedures performed) survived 5 years. Significant improvement of distant results was, observed in patients receiving EAP as an adjuvant therapy (25.1% of 5-year survivors) in comparison to control group patients treated solely with surgery (18.2% of 5 year survivors). In 97 patients after total gastrectomy, significantly lower complication rate was observed in patients in whom intestinal pouch was created (Hunt-Lawrence) than in patients in whom the pouch was not created (Roux-Y, Engel-Graham). CONCLUSION: In our opinion, we should consequently implement guidelines known as the "Polish Consensus of Gastric Cancer Treatment", like extensive radical stomach resection (whenever possible) with regional lymphadenectomy and adjuvant therapy.

[Reconstruction methods for the continuous digestive tract using surgical stapling after gastrectomy with lymphadenectomy in patients undergoing surgery for stomach cancer. Personal evaluation]. / Metody rekonstrukcji ciaglosci przewodu pokarmowego z uzyciem szwu mechanicznego po gastrektomii z limfadenektomia u chorych operowanych z powodu raka zoladka. Ocena wlasna.

From 1984 to 1994, 152 patients were operated for gastric cancer in Clinical Department of Surgical Oncology, Medical University of Lodz. Patients age ranged from 31 to 82 years (mean age-61.2). The purpose of this study was to evaluate the methods of reconstruction of gastrointestinal tract (GIT) continuity. Our material comprised patients who underwent total gastrectomy for gastric cancer. In 52 patients radical procedure--total gastrectomy--was performed, with reconstruction of gastrointestinal tract continuity. The latter part of surgery was accomplished using different methods: Roux-Y anastomosis-10 patients (19.2%); esophago-jejunal "end to side" anastomosis-8 patients (15.4%); Hunt-Lawrence-Rodino anastomosis-34(65%). During procedures staplers and VALTRAC rings were used, as well as ultrasound selector and argon coagulator for hepatic and pancreatic resections. Quality of life after gastrectomy was determined on the basis of interviews taken from patients, in whom GIT continuity was reconstructed with or without intestinal pouch creation. We also evaluated incidence and type of complications after such procedures. Perioperative mortality in our material was 7.7%. We concluded that the best results was achieved when continuity of gastrointestinal tract after total gastrectomy was reconstructed with intestinal (first loop of jejunum) pouch creation (Hunt-Lawrence procedure). This method warranted high quality of life and low incidence of complications. Staplers enables us to shorten time of procedure and to decrease the number of anastomosis leaks, so that our results of surgical treatment of patients with gastric cancer were better.

[Comparison of computed tomography results and pathological findings after laparotomy with splenectomy in Hodgkin's disease]. / Porównanie wyników tomografii komputerowej i patologicznej oceny zmian w jamie brzusznej po laparotomii ze splenektomia w ziarnicy zlosliwej.

In 69 patients (pts) with Hodgkin's disease (HD) in I-IIIA clinical stage results of abdominopelvic computed tomography (CT) were compared with pathological staging. Concordance (specificity) of CT scan with results of macroscopic evaluation of HD lesions in the abdomen during laparotomy with splenectomy was 83%. Accuracy CT results and microscopic findings was 80%. False positive results of CT were found in 11.6% of patients and false negative in 8.6%. Specificity and sensitivity of CT versus to pathological staging were 84% and 63% respectively. The results presented here confirm, that pathological staging after laparotomy with splenectomy in HD was some advantage in precise prediction of some patients to radiotherapy and planning of irradiated fields.

Glucose-6-phosphate dehydrogenase activity in erythrocytes of patients with malignant neoplasms.

G6PD activity in erythrocytes was examined in 129 people with malignant neoplasms (83 males, 46 females). In all these subjects G6PD activity in erythrocytes was markedly higher than in the controls. Tumour surgery resulted in decreased activity of that enzyme in the erythrocytes. The controls were 53 healthy persons (38 males, 15 females) not exposed occupationally to carcinogens.