THE PATIENT FACED THE REMOVAL OF HER ENTIRE STOMACH, BUT NMRRC SURGEONS REFUSED TO ACCEPT THIS OUTCOME

Three and a half hours – that’s how long oncological surgeons from the thoracoabdominal department of the P. Hertsen Moscow Oncology Research Institute – branch of the Federal State Budgetary Institution of the “National Medical Research Radiological Centre” of the Ministry of Health of the Russian Federation spent in the operating room to help a patient overcome an aggressive disease and return to a full life.

Elena, 65, a resident of Yalta, has dedicated her life to medicine. Some time ago, she began experiencing difficulty swallowing solid food and discomfort in her stomach area. She consulted a gastroenterologist, underwent the necessary examinations, and was diagnosed with adenocarcinoma of the upper part of the stomach involving the esophagus. The standard treatment for such patients usually involves complete or partial removal of the stomach, with the remaining part connected to the esophagus. This approach was suggested to Elena at many oncology clinics she visited. However, she continued to search for doctors who could offer a more optimal treatment option and eventually sought consultation at the P. Hertsen Moscow Oncology Research Institute.

Doctors warned the patient that after such operations, 90% of patients suffer from constant heartburn, significantly reducing their quality of life and causing substantial discomfort. “The issue is that, with this localization, the natural anatomical valve between the stomach and esophagus is also removed along with the upper part of the stomach and lower sections of the esophagus. Afterward, hydrochloric acid from the stomach freely enters the esophagus, causing constant heartburn,” explains senior researcher of the thoracoabdominal department of the P. Hertsen Moscow Oncology Research Institute Nuriddin Abdulkhakimov. “Because the aggressive acidic gastric environment damages the esophageal mucosa and constantly causes inflammation, it often leads to malignant processes in the esophagus in the future. Unfortunately, this is an irreversible process.”

To minimize risks and spare the patient from lifelong medication and additional surgeries in the future, the radiology surgeons of the Ministry of Health of the Russian Federation proposed an entirely new surgical approach: removing the proximal part of the stomach affected by the tumor and connecting it to the esophagus using a section of the small intestine. “Thanks to such reconstructive-plastic surgery, acid and bile reflux from the gastric stump into the esophagus practically does not occur,” explains Nuriddin Muradzhanovich. “We performed the operation laparoscopically, through small punctures in the abdomen. Additionally, during the reconstruction, we created two pathways for food to move through the digestive tract. Some will pass through the stomach and follow its anatomical route into the duodenum, while the other bypasses the gastric stump and goes directly into the small intestine.”

“In Russia, such operations are performed only in a few expert-level clinics. Today, our Center has the most experience, performing more than 30 such surgical interventions annually,” comments Andrey Ryabov, Deputy General Director for Surgery at the National Medical Research Radiological Centre. According to experts, these operations are considered some of the most technically complex in thoracoabdominal surgery. Performing them using minimally invasive technologies without large incisions allows the patient to recover quickly, maintain a high quality of life, and, importantly, creates conditions for the continuation of chemotherapy if necessary.