COMBINED RESECTIONS OF STOMACH CANCER

A.M. Sahakayan, Avetyan Mamikon

In the review indications to the combined resections for patients with a stomach cancer certain data are presented depending on localization and features of distribution of process, indicators of survival rate and the factors influencing on the prognoses. Indicators in some works, postoperative complications of 31.2 %, a lethality - 13.6 % and 5-year-old survival rate at T4 - 25 %, specify in efficiency en bloc the combined resections. The review testifies to ambiguity of the relation of experts to the combined resections in this connection, workings out in this direction are represented actually for improvement of results of treatment locally invasive of a stomach cancer.

COMPARATIVE EVALUATION OF STOMACH CANCER SURGICAL TREATMENT IN 71-YEAR-OLD AND OLDER PATIENTS

A.M. Sahakayan, H.P. Petrossyan. A.R. Akunc, A.M. Gabrielyan

In the surgical treatment of stomach cancer in elderly and seniie patients, a lot of items are still debatable. The statistics of more than 99 patients hospitalized between the years 1993-2007, aged over 71, regarding their clinical and therapeutical characteristics, are shown in this report. The investigation was done in two groups, those who were hospitalized before 2003 (including 47 observations) and those after 2003 (52 observations).

We find that the distention of surgical indications according to comcomitant diseases, as well as the application of spacious surgical interference in patients with relatively unfavo-urable clinical findings, give us the opportunity to improve the results of surgery and tumor resectability without increasing the rate of postoperative complications and mortality.

PREVENTION OF THE ARM EDEMA AFTER RADICAL MASTECTOMY

A.M. Sahakyan, A.R. Akunts, G.S. Asilbeky

The possibility of prevention of the arm edema after the surgical treatment of breast cancer with dissection of axillary lymph nodes has been studied Its frequency is 43%. The conducing factors are body weight of patients more than 61 kg, size of the tumour being 3 cm and more, prolonged lymphorrhagia, 3 and more courses of adjuvant chemotherapy, paracentetic method of lymph evacuation from axillary space. The use of Detralex in the dose of 500 mg during 4 months, beginning from the 3rd or 4th day after surgery, made it possible to decrease the frequency of thoracic limb edema up to 18,2%, which is considered to be a great achievement in improving patient's life quality.

SURGERY OF GASTRIC CANCER AMONG ELDERLY POPULATION

A. P. Petrosyan

Despite total reduction of incidence of gastric cancer recently, the gastric cancer morbidity is increasing among aging patients who underwent surgery and makes over 20%. The review enlights the current state of gastric cancer in the elderly group Controversy remains in concern of patients' selection for surgery, gastric resection levels, necessity and expandance of regional lymph nodes dissection. Evidently, further recommendations for improvement of surgery outcomes should be worked out for treatment of elderly patients with gastric cancer.

THE PROBLEM OF RESECTABILITY OF ADVANCED DISTAL GASTRIC CANCER

A.M. Sahakyan, A. V. Barseghyan, A.R. Akunts

The surgery of advanced gastric cancer remains a serious problem with high level of complications and poor outcome results. A comparative analysis was performed on the base of data of 420 patients with the advanced distal cancer of stomach. Wide application of palliative (both Rl and R2) and combined gastric resections together with extensive lymph dissections D2 lead to significant impro-vement of the indices of resectability up to 75,0%. However, a moderate increase of both the frequency of surgical complications and the mortality rate without reliable statistic difference (12,1% and 18,9%, P>0,05; 7,0% and 12,2%. P>0,05 respectively) have been recorded.

THE PROPHYLAXIS OF THROMBOTIC COMPLICATIONS FOR ONCOLOGIC PATIENTS

Sahakyan A.M., Akunts A.R., Gabrielyan A.M., Asilbekyan G.S.

During the work the contributing factors of thromboembolic disorders and the potentials of preparation "fraxiparin" are studied in their prophylaxis. The elderly age, the row of transferring and concomitant diseases, the level of creatinine 116 mcmol/L and more, palliative or extensive interventions, the duration of the operation more than 3 hours, regional or distant metastasis are risk factors in the development of thromboembolic disorders. The use of fraxiparin allows to lower the frequency of these complications to 1,9+1,3%, compared to 5,7+1,0% , which is significantly low (P<0,05). The preparation is an effective agent in the prophylaxis of postoperative complications for oncologic patients.