Improving of the efficiency of combined treatment for locally advanced gastric cancer with the use of neoadjuvant selective arterial oil chemoembolization
The study presents a summary of results of examination and treatment of 40 patients with locally advanced gastric cancer for the period from 2009 to 2015. The most frequently there were diagnosed III C and II B stages of the disease, while 62.5% of all cases were of stage III. Adenocarcinoma of low and moderate differentiation was diagnosed in 30 (67.2%) cases. Most cases (87.5%) occurred in the body and antrum. Men were 21 (52.5%), women - 19 (47.5%). The mean age of patients was 60.9±11.4 years. At the time of initiation of treatment complicated course of locally advanced gastric cancer was in almost all patients. Anemia of varying severity was diagnosed in 24, signs of bleeding were found in 6 patients. Subcompensated stenosis of the antrum was detected in 9 patients. All patients underwent diagnostic angiography to study the vascular anatomy hepatopancreatoduodenal zone as well as to determine the nature of vascularization of tumor of the stomach and the sources of its blood supply. In 34 patients, whose vascular anatomy of tumor was represented by the presence of main supply vessel, the first phase of the combined treatment was selective intraarterial oil chemoembolization. Surgical stage of combined treatment was carried out in 30 patients. Distal subtotal gastrectomy was performed in 13 patients, total gastrectomy - 15 patients. Radical removal tumor (R0) was achieved in 26 patients with a relatively small number of postoperative complications. Wherein optimum interval between rentgenoendovascular intervention and surgery was 1-4 weeks, during which primary response of tumor and its metastases in regional lymph nodes on neoadjuvant regional chemotherapy was maximally realized.