Life without a stomach
D2 lymph node dissection (removal of 25+ nodes along the vessels of the celiac trunk) is the key to prognosis and accurate staging; Roux-en-Y reconstruction prevents the reflux of bile into the esophagus. Nutrition is being restructured: fractional portions 6–8 times a day, gradual expansion, B12 for life, enzyme support - the patient and family are educated before discharge, a nutritionist accompanies. Perioperative chemotherapy according to the protocol (before and after) improves results - the plan is built by the consultation from the very beginning. Observation with endoscopy and CT as scheduled.
Indications
- stomach cancer - gastrectomy/resection with lymph node dissection D2;
- tumors of the colon and rectum with complications - resection with colostomy (Hartmann operation);
- metastases and primary liver tumors - atypical resections;
- adhesive process involving the intestine in tumors - resection with restoration.
Oncological standards
Radicality in abdominal oncology surgery is determined by the margins of resection and lymph node dissection: for gastric cancer - D2 (removal of 1st and 2nd order nodes), for colorectal cancer - resection with mesentery (CME/TME). Complicated tumors (obstruction, perforation) are operated on in stages: first, eliminating the threat with a colostomy, then restoring continuity. Hepatic metastases of colorectal cancer are resected with a good prognosis if completely removed. Each case goes through a consultation; perioperative chemotherapy is planned according to protocols.
