Альманах клинической медицины. 2019; 47: 707-711
Есть ли место мультивисцеральным резекциям в лечении рака желудка?
https://doi.org/10.18786/2072-0505-2019-47-081Аннотация
Общеизвестно, что мультивисцеральные резекции (МВР) сопровождаются значительным числом послеоперационных осложнений. Однако до сих пор идут дискуссии об эффективности МВР в отношении увеличения продолжительности жизни больных. Оправданы ли риски операций расширенного объема? Ранее предполагалось, что удаление соседних органов может улучшить прогноз заболевания, даже в отсутствие прямой инвазии. Но в эпоху широких возможностей химио- и лучевой терапии выполнение сверхрасширенного хирургического объема без прорастания опухоли вызывает сомнения. При наличии метастазов в регионарные лимфоузлы МВР не улучшают прогноз в сравнении с паллиативными резекциями. В случае если у пациента есть отдаленные метастазы либо операция проведена заведомо нерадикально, МВР ухудшают прогноз. Если степень инвазии T4b и нет жизнеугрожающих осложнений, оптимально начать неоадъювантную химиотерапию или провести периоперационную химиотерапию. При интраоперационном подозрении на вовлечение соседних анатомических структур в отсутствие отдаленных метастазов показана резекция en bloc в сочетании с D2-лимфодиссекцией. Приблизительно в 30–60% наблюдений инвазия морфологически не подтверждается. Единственный путь улучшения результатов хирургического лечения больных раком желудка – тщательная оценка распространенности заболевания на дооперационном этапе, отбор больных и работа хирургов в команде с химиотерапевтами, радиологами и диагностами.
Список литературы
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Almanac of Clinical Medicine. 2019; 47: 707-711
Is there a place for multivisceral resections in the treatment of gastric cancer?
https://doi.org/10.18786/2072-0505-2019-47-081Abstract
It is known that multivisceral resections (MVR) are associated with significant numbers of post-operative complications. However, the effectiveness of MVR in increasing the patients' life expectancy remains a matter of debate. Are the risks of extended volume resections justified? It has been previously assumed that the removal of adjacent organs could improve the prognosis of the disease, even in the absence of direct invasion. However, in the era of the big potential of chemoand radiation therapy, the implementation of an over-extensive surgical volume in the absence of tumor invasion is doubtful. In the presence of regional lymphatic nodes metastases, MVR do not improve prognosis, compared to that after palliative resections. If the patient has distant metastases, or the operation has been obviously not radical enough, MVR worsen the prognosis. In grade T4b invasion and with the absence of life threatening complications, it is optimal to start with neoadjuvant or perioperative chemotherapy. In the case of intraoperative suspicion of adjacent anatomical structures involvement, with no distant metastases, en bloc resection in combination with D2 lymphodissection is indicated. In approximately 30–60% of cases, invasion is not confirmed by histology. The only way to improve the results of surgical treatment of gastric cancer patients is to carefully assess the extension of the disease at the preoperative stage, select patients and team work of surgeons with chemotherapists, radiologists and specialists in diagnostics.
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