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Actualităţi în epidemiologia, etiopatogeneza, diagnosticul, tratamentul şi profilaxia tumorilor maligne. Tratamentul complicaţiilor cancerului gastric

Author: Ghidirim Nicolae
Degree:doctor habilitat of medicine
Speciality: 14.00.14 - Oncology and Radiotherapy
Scientific consultants: Gheorghe Ţîbîrnă
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Gurie Coşciug
doctor habilitat, professor, Public Medical Sanitary Intitution Institute of Oncology
Scientific council:


The thesis was presented on the 29 January, 2008
Approved by NCAA on the 28 February, 2008


Adobe PDF document0.91 Mb / in romanian


A general summary of the present work can be made based on the publications and the review of specialized literature. The basic published works allow presenting modern concepts (hypotheses) regarding the main oncological fields.

As of today, we are closer to understanding the causes and mechanisms of onset of malignant tumors. New concepts of carcinogenesis have been developed, the role of carcinogens (physical, chemical, biological, genetic, immunological etc.) has been determined. At the same time, the character of precancer in certain localizations has been specified, and modern preventive measures concerning localization of this disease have been developed. Based on the accumulated material, clinical oncology methods have been presented, which rely on a wide range of cytostatics, providing an interpretation of their mechanisms of action on cancer cells.

The range of chemotherapy medication is becoming more diversified, especially, in terms of polychemotherapy, which assumes that the medication is acting throughout the cellular cycle, working at the level of DNA or RNA.

The hormonotherapy and immunotherapy of malignant tumors with the application of interleukins, and especially monoclonal antibodies, are widely represented.

Early diagnosis and treatment of the complications of gastric cancer have a special place in the present work.

Over a period of 15 years (1992-2006), 450 patients with various complications were examined and treated, of which 332 (73.8%) – with pylorostenosis; 93 (20.66%) – with hemorrhage; and 25 (5.6%) – with perforation of gastric tumor. Each type of complication is dedicated a separate chapter, comprising modern literature sources and description of clinical picture, and methods of diagnosis and treatment.

153 operations of the total number of 450 had a radical character, constituting 34% (42 operations with hemorrhage, 103 with pylorostenosis and 8 with perforations), of which 16 were gastrectomies; 7 – gastrectomies with splenectomy; 127 – subtotal distal resections; and 3 – subtotal proximal resections. In 263 cases palliative operations were performed, constituting 58.44% (40 with hemorrhage, 208 with pylorostenosis and 15 with perforations). In 34 cases (7.55%) exploratory operations were performed.

In all lethality was registered in 30 cases (6.6%), of which 14 patients died with hemorrhage of the total number of 93 patients with hemorrhage, constituting 15.05%; 5 patients – with pylorostenosis of the total number of 332 patients with pylorostenosis, constituting 1.5%; and 11 patients – with perforations of the total number of 25 patients with perforations, constituting 44%.

As it is evident from the foregoing material, the highest postoperative lethality is registered in the cases of perforations of tumors, which can be explained by the fact that such operations were performed under the worst possible conditions in the presence of diffuse peritonitis, as a rule.

Nevertheless, the results of our research demonstrate that in certain cases the severe complications of gastric cancer aren’t always a consequence of an advanced tumor. On the contrary, tumors can be diagnosed due to the symptoms of respective complications, forcing the patients to seek help at early stages of the disease. Thus, radical emergency operations are performed by surgeons, increasing the patients’ chances of full recovery.

In conclusion, we consider that the description of the clinical picture, and the methods of diagnosis and treatment, alongside with the diagrams of emergency operations in the cases of complications of gastric cancer, will contribute to facilitating the correct decision-making by surgeons and oncologists, when treating such patients.