Krebserkrankungen des Magens (Magen)
The stomach is an important organ of the digestive system anatomically located in the epigastric region. It is adjacent to the liver on the right side and the spleen on the left side. The pancreas is followed by the head, body and tail on the posterior wall of the stomach. Its lower wall is adjacent to the Transverse Colon. The stomach is one of the organs with the highest blood supply among the organs in the body.
The stomach consists of four parts. These are Fundus, Corpus, Antrum and Pylorus.
The number of arteries feeding the stomach is quite large. The largest artery is the left gastric artery originating from the turuncus celiac. Among the other vessels, the main ones are A.Gastrika Dextra, A.Gastroepiploika Dextra, A.Gastroepiploika Sinistra and Gastrika Breves.
Stomach ,from the inside out, consists of the mucosa, submucosa, muscular layer and sero.
Like all organs, the stomach has many lymph nodes. For the stomach, these lymph groups are D1, D2 and D3 group lymph nodes. The importance of these lymph nodes is one of the most important factors determining the survival time of the patients in cancer surgery. In gastric cancers, in whichever part of the stomach the cancer is located, the entire drainage of the relevant lymphatic region should be surgically removed. During cancer surgery, all lymph nodes that provide drainage that fit the relevant area should be removed. In gastric cancer surgery, the surgeon must remove at least 15 lymph nodes for pathological staging.
During the surgery to be performed in cancer of every intra-abdominal organ, a certain number of lymph nodes should be removed together with the surgical specimen in order to increase the survival time.
When we look at the literature, while the relevant cancerous organ is removed in cancer surgery, lymphatic nodes and vessels, which have an important role in the spread of this cancer to the whole body, should be removed as much as possible, so as not to cause morbidity and mortality. The nodules that need to be removed here should be grouped according to the surgical operation to be performed by the surgeon before the operation, and the anatomical location of these lymph nodes and their close relationship with the vascular structures should be well known.
If the surgeon has limited knowledge and experience on vascular system, the Surgeon may hesitate to remove these structures located near these vital vessels. It should not be forgotten that one of the conditions that prolong the patient’s survival time is undoubtedly an effective surgical and lymphatic dissection.
Some blood tests, Endoscopy, Complete Abdominal Ultrasonography and Complete Abdominal Tomography are important in the diagnosis of stomach cancer. In some cases, additional tests may be required based on the results of these tests. By looking at these examinations, it is decided whether the treatment of the patient is drug treatment or surgical treatment.
The surgical treatment of gastric tumors depends on many factors. One of them is the area where the tumor is located. If the tumor is towards the end of the stomach, that is, we include the Antrum and the pylorus, then the operation to be performed is Subtotal Gastrectomy, if the tumor includes the Corpus (middle part), Fundus or cardia region of the stomach, then Total Gastrectomy is required. In both cases, connections from the small intestines are required to ensure the continuity of the gastrointestinal tract anatomically.
After the operation, no oral feeding is given for 3 or 4 days in total, and all the needs of the patient are provided through the vein with IV and supplementary drugs in IV. If it is seen that everything is going well, oral feeding starts on the 3rd or 4th day and if it is concluded that there is no problem on the 6th day, the patient is discharged with some suggestions. Patients who have a part of their stomach removed do not need to pay attention to anything for nutrition after surgery. However, patients who have a new stomach that is created from the small intestine by removing the entire stomach may need to pay close attention to their nutrition, to be fed small portions and often, and to take some nutritional supplements.
When the specimen pathology results come out, treatment modalities such as smart drugs, chemotherapy or radiotherapy may be needed according to the pathology report with a medical oncologist and the technical details of the patient’s surgery. The determining factor in all these is the stage of the actual disease. If the stage of the disease is in the very early stages, the patient can be followed up without the need for any oncological treatment protocol. One of the factors determining the stage is the number of lymph nodes removed and whether they have tumor involvement.
In fact, the important thing here is that the surgeon approaches the related cancer as a whole and that all lymph nodes, which are the extensions of the related tumor, are removed by adding them to the specimen, so as not to increase the morbidity and mortality rates.