ĐẶC ĐIỂM TỔN THƯƠNG VÀ KẾT QUẢ PHẪU THUẬT UNG THƯ DẠ DÀY TIẾN TRIỂN XÂM LẤN ĐẦU TỤY, TÁ TRÀNG, CUỐNG GAN (40 TRƯỜNG HỢP)

Abstract

Aime of study: Retrospective study aim at evaluating the characteristic lesions and surgical results of Locally Advanced Gastric Cancer Invading Duodenum, Head of pancreas or Hepato-Duodenum ligament. Rersults: There were 40 patients, mean age: 63,08±1,73 Y, Male 82,5%, Female 17,5%. Clinical features: Epigastric pain in 100%; Melena in 62,5%; Gastric outlet obstruction in 85,0%. Weight loss in 82,5%; Panpable tumor in 27,5%. Distal gastric cancer in 100%: Among them, pyloric tumor in 25%; Antral-pyloric tumor in 52,5%,; antral tumor in 7,5%; antral tumor invaded lesser curvature in 15%. Tumor diameter ≤ 5 cm in 60%. Gastric outlet obstructions (by gastro duodenal scopy) in 42,5%. CTScan revealed tumor invaded duodenum or head of pancreas in 15%. Intra operation lesions: Gastric tumor invaded duodenum in 92,5%, tumor invaded head of pancreas in 60%, tumor invaded hepato-duodenal ligament in 35%. Surgical Procedure: Radical Gastrectomy with D2 lymph node dissection in 92,5%, palliative gastrectomy in 7,5%. Pathological resuls: poorly differentiated carcinoma in 47,5%; Moderately differentiated carcinoma in 27,5 %;signet Ring Cell carcinoma 20%; Mucinous adenocarcinoma in 5%. Stage (AJCC): Stage IB in 2,6% (T2N0M0); Stage IIA in 2,6%, (T2N1M0); Stage IIIb in 40,0%; Stage IIIc in 47,5% ; Stage IV in 7,5%. Conclusions: 40 patient, mean age 63,08±1,73 Y; male 82,5%, Female 17,5%, Sex ratio 4,7. Tumor location (gastroduodenal finding): Distal gastric cancer in 100%: Tumor diameter ≤ 5 cm in 60%. Gastric outlet obstruction (gastro duodenal scopy) in 42,5%. CTScan finding: Tumor invaded duodenum or head of pancreas in 15%. Intra operation lesions: gastric tumor invaded duodenum in 92,5%, tumor invaded head of pancreas in 60%, tumor invaded hepato-duodenal ligament in 35%. Surgical Procedure: Radical Gastrectomy with D2 lymph node dissection in 92,5%, palliative gastrectomy in 7,5%. Duodenostomy in 55,0%; round ligament plasty in 40,0%; Interrupted suture and reinfore suture to pancreatic head in 45%. Mortality and complication: There was no death intra and post operation. Duodenal fistula in 15%.     Pathological resuls: Poorly differentiated Carcinoma in 47,5%; Moderately differentiated Carcinoma in 27,5 %;signet Ring Cell Carcinoma 20%; Mucinous Adenocarcinoma in 5%. Stage (AJCC): Stage IB 2,6% (T2N0M0); Stage IIA in 2,6%, (T2N1M0); Stage IIIb in 40,0%; Stage IIIc in 47,5% ;Stage IV in 7,5%.