PECULIARITIES OF POSTOPERATIVE PERIOD OF PATIENTS WITH ESOPHAGEAL CANCER AND GASTROESOPHAGEAL CANCER
Authors: Starikov V. I. , Hodak A .S. 
Published: October 2022

Abstract. Introduction. To date, complete cure from esophageal cancer/MS/and gastroesophageal cancer/GER/can only be achieved surgically. At the same time, the five-year survival rate of patients is from 25 to 35 % according to various authors. At the same time, postoperative mortality in MS and GER reaches 15%, and only in leading clinics it is 3–9 %. In the treatment of cancer of these localizations, there are many controversial issues, namely the issue of optimal surgical access in cancer of various anatomical departments of the esophagus and GER, the volume of lymphodissection, the reconstructive stage of surgery, the relation to splenectomy. There is insufficient information on the prevention and treatment of postoperative complications.

Purpose. Establish the nature of postoperative complications in patients with MS and GER and study the possibilities of preventing their development.

Materials and methods. The results of surgical treatment of 219 pa-tients with esophageal cancer/MS/and gastroesophageal cancer/ GER/are presented. The patient underwent surgical interventions according to the method of Lewis/98/and Osava-Garlock/121/. The formation of esophageal-gastric anastomosis was carried out manually without the use of cross-linking devices. Preferred plastic submerged esophageal-gastric anastomosis, which has high reliability and good functional properties. Postoperative complications and factors that cause them were analyzed. The clinical case of diagnosis and treatment of gastric graft rotation is presented.

Research results. Complications in the postoperative period occurred in 34.95 % of patients. The leading place was occupied by somatic complications: cardiovascular 17.1% and pulmonary 12.0 %. Complications from esophageal ventricular anastomosis occurred in only 4 (1.8%) patients, and in no case this led to the death of the patient. Intrapleural bleeding from the chest wall (1.4 %) and gastric cookies (1.0%) were very rare. There are also complications in the form of gastric graft rotation and complete obstruction. This complication was eliminated by the imposition of gastroenteroanastomosis on the abdominal gland of the stomach in laparotomy.

Deaths were caused in 3 (1.4 %) patients with cardiovascular insufficiency and in 1 (0.5 %) patient with TELA.

Conclusions. Prominent in the structure of postoperative complications are therapeutic: cardiovascular and pulmonary, they account for more than 80% of all complications. The most common cardiovascular complication is a heart rhythm disorder.

The method of formation of esophageal anastomosis is a separate independent side of the problem. The search for the optimal method continues. However, in our opinion, the result depends not so on the method used, but how this method corresponds to the principles of optimal healing of anastomosis and the correctness of its technical performance.

For the prevention of transplant rotation during surgery, control of its location, both from the chest and abdominal cavity, is necessary, so the latter is sutured only after the formation of esophageal-gastric anastomosis.

In gastric graft rotation, urgent surgery is shown to perform drainage surgery.