TY - JOUR

T1 - The tactics of surgical treatment for gastric bleeding tumors in elderly and senile patients

AU - Sigua, B. V.

AU - Zemlyanoy, V. P.

AU - Gubkov, I. I.

AU - Danilov, A. M.

AU - Sakhno, D. S.

AU - Zakharov, E. A.

AU - Guslev, A. B.

N1 - Publisher Copyright: © 2018 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

PY - 2018

Y1 - 2018

N2 - The results of treatment of 112 patients of elderly and senile age patients with non-metastatic gastric cancer, complicated by bleeding were analyzed. Most often bleedings occurred for stomach cancer stage III-IV. The tumor was commonly located in the gastric body. The vast majority of patients had only one complication - bleeding. In the second (control) group, there was no unified diagnostic and treatment algorithm, patients were usually operated urgently upon admission or in case of recurrent bleeding. The differential diagnostic and treatment algorithm was developed for patients of group I (main) taking into account the condition of a patient and the severity of bleeding or repeated bleeding. In the control group, the indications for emergency surgery were continued bleeding and inefficiency of endoscopic hemostasis. In the main group, the risk of recurrent bleeding was considered as well, and in case of high risk emergency surgery was performed after a full preoperative preparation. In addition, the cardial part or 2/3 of the stomach were not resected by reason of the deliberate non-radical tactics. It is worth noting that in the I group argon plasma coagulation, complemented by the hemostatic system EndoClot was used for endoscopic hemostasis. Through the use of the developed algorithm we managed to reliably reduce the frequency of complications from 50 to 28.5% (p<0.05), and mortality rate from 28.8 to 3.77% (p<0.001).

AB - The results of treatment of 112 patients of elderly and senile age patients with non-metastatic gastric cancer, complicated by bleeding were analyzed. Most often bleedings occurred for stomach cancer stage III-IV. The tumor was commonly located in the gastric body. The vast majority of patients had only one complication - bleeding. In the second (control) group, there was no unified diagnostic and treatment algorithm, patients were usually operated urgently upon admission or in case of recurrent bleeding. The differential diagnostic and treatment algorithm was developed for patients of group I (main) taking into account the condition of a patient and the severity of bleeding or repeated bleeding. In the control group, the indications for emergency surgery were continued bleeding and inefficiency of endoscopic hemostasis. In the main group, the risk of recurrent bleeding was considered as well, and in case of high risk emergency surgery was performed after a full preoperative preparation. In addition, the cardial part or 2/3 of the stomach were not resected by reason of the deliberate non-radical tactics. It is worth noting that in the I group argon plasma coagulation, complemented by the hemostatic system EndoClot was used for endoscopic hemostasis. Through the use of the developed algorithm we managed to reliably reduce the frequency of complications from 50 to 28.5% (p<0.05), and mortality rate from 28.8 to 3.77% (p<0.001).

KW - Argon plasma coagulation

KW - Elderly and senile age

KW - EndoClot system

KW - Gastric bleeding

KW - Gerontology

KW - Individual treatment algorithm

KW - Non-metastatic gastric cancer

KW - Re-occurrence of bleeding

UR - http://www.scopus.com/inward/record.url?scp=85051729913&partnerID=8YFLogxK

U2 - 10.23934/2223-9022-2018-7-2-152-155

DO - 10.23934/2223-9022-2018-7-2-152-155

M3 - Article

AN - SCOPUS:85051729913

VL - 7

SP - 152

EP - 155

JO - Russian Sklifosovsky Journal of Emergency Medical Care

JF - Russian Sklifosovsky Journal of Emergency Medical Care

SN - 2223-9022

IS - 2

ER -