Laparaskopik gastrik kanser cerrahisinde erken dönem sonuçları

Year 2019, Volume: 44 Issue: 4, 1347 - 1356, 29.12.2019

Orçun Yalav , Uğur Topal , Ayşe Gizem Ünal Ahmet Rencüzoğulları , İsmail Cem Eray Ahmet Gökhan Sartıaş

https://doi.org/10.17826/cumj.529972

Abstract

Amaç: Bu çalışmada bir üniversite kliniğinde gerçekleştirilen laparoskopik gastrektomilerin erken dönem sonuçlarının paylaşılması amaçlanmıştır.

Gereç ve Yöntem: Eylül 2015- Eylül 2018 tarihleri arasında yapılan laparoskopik gastrektomiler total ve distal olmak üzere iki gruba ayrılmış,  teknik, patolojik sonuç ve erken postoperatif komplikasyonlar açısından incelenmiştir.

Bulgular: Çalışmaya 11’i erkek, 7’si kadın olmak üzere 18 hasta dahil edilmiştir. Yaş ortalaması 57,4 olup, ortalama BMI 26,3 idi. 13 hastada cerrahi ilk planda tutulmuş sadece beş hastaya neoadjuvan tedavi protokolü uygulanmıştır. Total gastrektomi 14 hastada, distal gastrektomi 4 hastada tercih edilen ameliyat yöntemidir. Tüm hastalara tümör yerleşimine göre standart D2 lenf disseksiyonu uygulandı ve Total gastrektomi grubunda Ortalama 33,2 distal gastrektomi grubunda 32 lenf nodu disseke edildi. Ortalama oral başlama süresi ve Total gastrektomi grubunda 6,4 gün distal gastrektomi grubunda 2,5 gün idi. Duodenal güdük kaçağı 4 hastada, özefagojejunostomi kaçağı 2 hastada tespit edilirken 1 hastada da dren yerinde kanama görüldü.

Sonuç: Laparoskopik gastrektomi ve lenfatik disseksiyonun yeterliliğini gösteren birçok çalışma bulunmaktadır. Ancak öğrenim süreci uzun, teknik zorlukları fazla olan bu ameliyatlarda deneyim ve tecrübe arttıkça ameliyat sürenin kısalacağını ve komplikasyon oranının azalacağını düşünmekteyiz.

Keywords

Mide kanseri, Laparaskopik gastrektomi

Early results in laparoscopic gastric cancer surgery

Abstract

Purpose: The aim of this study was to evaluate the early results of laparoscopic gastrectomy performed in a university clinic.

Materials and Methods: Laparoscopic gastrectomy performed between September 2015 and September 2018 were divided into two groups as total and distal, and evaluated in terms of the technical, pathological and early postoperative complications.

Results: Eighteen patients (11 male and 7 female) were included in the study. The mean age was 57.4 and the mean BMI was 26.3. Surgical treatment was prioritised in 13 patients and only five patients underwent neoadjuvant treatment protocols. Total gastrectomy was the preferred surgical method in 14 patients and distal gastrectomy in 4 patients. All patients underwent standard D2 lymph dissection according to tumor localization and 33.2 was the mean number of lymph nodes dissected in the total gastrectomy group; while a mean of 32 lymph nodes were dissected in the distal gastrectomy group. The mean oral start time was 6.4 days in the total gastrectomy group and 2.5 days in the distal gastrectomy group. Duodenal stump leak was detected in 4 patients, esophagojejunostomy leak was detected in 2 patients, while 1 patient had bleeding in the drain location.

Conclusion: There are many studies demonstrating the adequacy of laparoscopic gastrectomy and lymphatic dissection. However, we believe that as the experience increases in these surgeries with many technical difficulties and a long learning duration; the operation time will be shortened and the complication rate will decrease.

Keywords

Gastric Cancer, laparascopic gastrectomy

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