gastro-congress-2019-scientifictracks

47 / 60

Page 47
conferenceseries.com
Volume 09 Journal of Gastrointestinal & Digestive System
ISSN: 2161-069X Gastro Congress 2019
July 08-09, 2019
July 08-09, 2019 | Zurich, Switzerland
14th Euro-Global Gastroenterology Conference
Multivisceral resection for advanced gastric cancer: Case report
Maksim A Evseev
Volyn Hospital, Russian Federation
In regardof permanent discussionabout necessity andpossibilityofmulti visceral resections inadvancedmalignancy,
we present a clinical case Multi visceral resection total gastrectomy, pancreaticoduodenal resection and the
extended right colectomy. A woman 39 years was examined about the violation of gastric emptying and symptoms of
gastric bleeding, appeared 2 months prior to treatment. After the examination stomach cancer (poorly differentiated
adenocarcinoma, antrum, body and Borrmann III) with the spread to duodenum, invasion of pancreatic head, with
involvement of perigastral lymph node without distant metastases was diagnosed. At intraoperative examination
circular tumor of stomach with involvement of antrum, body, subcardia, spreading to proximal part of duodenum
and Invasion of pancreatic head, right flexure of the colon, right Para colon and mesocolon with middle colic vessels,
metastatic lesion of lymph node in groups 3, 4d-7, 15 were detected (oT4N1M0, fT4N2M0 (R0)). Total gastrectomy,
pancreatoduodenectomy, extended right colectomy with regional lymphadenectomy D2-3 (lymph nodes of groups
1-13, 14v, 15, 16b1 were removed) were performed. Reconstructive phase of surgery included the formation of
nutritional and biliopancreatic loops of the small intestine by Y-en-Roux. In time of the alimentary loop formation
esophagoenterostomy and Iliodescendostomy were performed. In the biliopancreatic loop have been performed
invaginated pancreaticoenterostomy and hepaticoenterostomy. Surgery was completed insertion of transnasal
feeding tube in the alimentary loop and four drainages in the abdominal cavity. Postoperative period has been
executed according to ERAS with enteral nutritional and physical activation at one day after surgery. There were
no complications in the postoperative period. Final diagnosis was the patient was discharged on day 10 in a good
condition for adjuvant chemotherapy (XELOX). Within 12 months of observation after 6 months of the adjuvant
treatment no local or metastatic progression of tumor and no dyspeptic symptoms have been identified.
J Gastrointest Dig Syst 2019, Volume 09