According to worldwide statistics breast cancer is the most common cancer in women. Despite the success in current methods of treatment post-operative period in major of patients is characterized by post-mastectomy syndrome which leads to impairment in daily activities, difficulties in social adaptation and consequently to dicrease of the quality of life. The specific causes, risk factors, characteristics of clinical and pathogenetic manifestations of post-mastectomy syndrome are described in detail in this review. Different approaches to post-mastectomy syndrome classification, its clinical and instrumental diagnosis are defined. Based on more than 40 publications of Russian and foreign authors, the issue of selection of appropriate treatment tactics for the syndrome is investigated and discussed in detail. A considerable part of the review is focused on the use of physical methods of treating the post-mastectomy syndrome. It is observed that an increasing number of specialists gives preference to methods of conservative treatment special of which are medical gymnastics, complex decongestive therapy and compression therapy. On the other hand, the absence of the unified treatment algorithms is challenging for clinicians. Therefore, its development with the focus on patient-specific approach is a crucial task for modern rehabilitology in breast cancer surgery.
There is no consensus regarding the operation of choice for pathological changes in the proximal stomach, distal esophagus and the area of the cardio-esophageal junction to the present day. In addition to malignancy and peptic ulcer disease, a refractory course of gastroesophageal reflux disease (GERD) and the absence of any effect from primary antireflux surgery may be an indication for performing cardiectomy with reconstruction. To make a choice of the surgical treatment for pathologies of the distal esophagus and proximal stomach method, it is necessary to compare the efficiency and safety profiles of these techniques in many parameters. The main indicators of the effectiveness of reconstructive operations after cardiectomy, are the frequency and severity of a large group of functional disorders characterized as “dumping syndrome” or “postgastrectomy syndrome”. A huge number of different types of anastomosis after cardiectomy has been proposed and studied. Nevertheless, an an objective evaluation of the results of these anastomosis types’ use, indicates that the hopes placed on them did not come true in most cases. It indicates insufficient coverage of this problem in scientific literature, despite the continuing interest of surgeons.
Proximal gastric resection (PGR) is still one of the most difficult and dangerous surgical interventions, and it is the only method of curative treatment of diseases of the cardiac part of the stomach in many cases. 5 types of gastrointestinal reconstruction are mainly performed after PRG: submerged rectal esophagogastroanastomosis, antireflux interposition of the jejunal segment, interposition of the jejunal segment of the jejunal pocket, interposition of the jejunal segment as a double tract and reconstruction with the formation of a gastric tube. Modern literature includes many works devoted to the development of methods of physiological reconstruction after subtotal and total removal of the stomach; however, none of the existing methods is recognized as optimal. Among the main indicators characterizing the effectiveness of PGR are the frequency and severity of the development of a large group of functional disorders, characterized as «diseases of the operated stomach», or «post-gastro-resection disorders», which significantly worsen the quality of life (QOL) and reduce the working capacity, which causes disability of the operated patients Assessment of QoL after surgery for diseases of the cardiac stomach is a fundamentally important component of monitoring the effectiveness of treatment and, therefore, allows one to determine the indications for certain types of interventions. The available world scientific literature does not provide convincing data on the assessment of QOL in patients after proximal resection for cardiac part of the stomach diseases, since there are no clear criteria for its assessment depending on the chosen methods and methods of reconstruction of gastrointestinal tract (GIT). In this regard, there is a need for further study of proximal resection with reconstruction of the gastrointestinal tract in surgical diseases of the cardiac part of the stomach on the basis of analysis of immediate and long-term results, as well as the quality of life of patients who underwent these surgical interventions.
The aim of the study was to assess the quality of life (QoL) in patients exposed to proximal resection of the stomach in various modifications. Materials and methods. The study included 97 patients who underwent surgical treatment of the gastric cardia disease; of them, 87.6% having malignant neoplasms. The patients were exposed to proximal gastric resection using isoperistaltic jejunogastroplasty (Merendino-Dillard-modified) (50 patients, main group I) and conventional proximal gastric resection using direct esophagogastroanastomosis (47 patients, control group II). The Russian language versions of the Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36 scale) (psychometric parameters) and Gastrointestinal Symptom-Rating Scale (GSRS) (gastrointestinal parameters) were used to assess health-related quality of life (HRQoL) in the patients before surgery and 12 and 24 months after it.Results. The results obtained demonstrated deterioration in the quality of life of patients both in physical (on average, by 36,51,8 scores or 31,4%) and psychological (on average, by 34,31,8 scores or 34,3%) health parameters according to MOS SF-36 scale before surgical treatment. In the postoperative period, in 12 and especially in 24 months, there was an improvement in physical and psychological health parameters above 70 scores; the patients of group I recovered faster and averaged 84,84,1 scores (significantly closer to the population norm - 86,52,7 scores), and in patients of group II this parameter was 75,33,1. As assessed using the GSRS questionnaire, there were the least disturbances in the digestive system functioning after proximal gastric resection with the Merendino-Dillard-modified gastroplasty (in 12,0% of cases), compared to esophago-gastrostomy (in 30,0% of cases); the results are relevant (rxy=0,6970,009; p0,01). Proximal gastric resection with the Merendino-Dilard-modified digestive tract reconstruction creates more optimal conditions for the rapid rehabilitation of functional parameters, which positively affects the quality of life of patients. Conclusion. The results obtained reflect the impact of the gastric cardia disease and its symptoms on the health and vital activity of patients before surgery and demonstrate how significant and effective the surgical treatment is.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.