Lazyrskyi V. Clinical and experimental substantiation of the choice of reconstruction and restoration operations after combined gastrectomy.

The work is devoted to improving of the results of treatment of patients with complications of locally advanced gastric cancer by improving existing and developing new methods of surgical treatment, as well as individualizing treatment tactics based on the causes of unsatisfactory results of treatment, determining the incidence of gastric cancer, developing a two-stage treatment algorithm, predicting the risk of pathological post-gastrectomy syndromes. The results of experimental studies with the reproduction of the model of the artificial stomach and the subsequent study of the morphological condition of the ileocecal segment of the intestine and esophagus are presented. They reflect the development of adaptation processes in the transplant at various times after gastroplasty and determine the possibility of using the ileocecal segment of the intestine at the reconstructive stage after combined gastrectomy. Variants of the complications of locally advanced gastric cancer are presented in a large clinical material: acute gastric bleeding, stenosis and perforation of the stomach tumor and their combinations. Tactical approaches were determined in patients of this category with priority use of minimally invasive technologies in the first stage of surgical treatment. Radical combined surgical interventions for various types of local cancer of the stomach are proposed. The use of the developed combined operations with resection of the pancreas, liver, colon, esophagus, and multivisceral resection reduced the number of palliative and symptomatic surgeries from 70.8% to 27.2% and increased radical treatment from 29.2% to 72.8%. The place of various reconstructive operations at the recovery stage after combined gastrectomy is determined depending on the volume of resection of neighboring organs, the severity of the patient's condition, the degree of disruption of homeostasis and the propensity to develop pathological post-gastrectomy syndromes. It was shown that with the spread of the gastric tumor on the colon, after combined gastrectomy, at the restorative stage, the method of choosing of the reconstruction of the digestive tract is gastroplasty by the ileocecal segment of the intestine.