Mide Kanseri Cerrahisi ve Mide Rekonstrüksiyon Yöntemleri
Özet
Mide kanseri, dünya genelinde yüksek mortalite oranlarına sahip olup, günümüzde tek küratif tedavi seçeneği cerrahi rezeksiyondur. Tümörün mide içerisindeki yerleşim yerine ve histolojik alt tipine bağlı olarak total gastrektomi veya distal subtotal gastrektomi tercih edilmekte, onkolojik güvenliği sağlamak adına D2 lenf nodu diseksiyonu standart yaklaşım olarak kabul görmektedir. Hastalığın sınıflandırılmasında histolojik olarak Lauren ve Dünya Sağlık Örgütü sistemleri, özofagogastrik bileşke tümörleri için ise Siewert şeması kullanılmaktadır. Çok erken evre olgularda endoskopik mukozal rezeksiyon (EMR) ve endoskopik submukozal diseksiyon (ESD) gibi minimal invaziv yöntemler başarıyla uygulanabilirken; evreleme aşamasında laparoskopi, peritoneal yayılımın tespiti açısından kritik bir rol oynamaktadır. Son yıllarda yapılan çalışmalar, laparoskopik gastrektominin açık cerrahiye kıyasla daha az kan kaybı ve daha düşük postoperatif komplikasyon riski sunduğunu, uzun vadeli sağkalım oranlarında ise benzer sonuçlar sağladığını ortaya koymuştur. Cerrahi sonrasında sindirim sisteminin devamlılığını sağlamak amacıyla Roux-en-Y özofagojejunostomi, Braun anastomozlu Loop özofagojejunostomi ve Jejunal J poşlu Roux-en-Y gibi farklı anatomik rekonstrüksiyon yöntemleri başarıyla uygulanmaktadır.
Gastric cancer is a leading cause of cancer-related mortality worldwide, with surgical resection remaining the only curative treatment option. Depending on the tumor location and histological subtype, either total gastrectomy or distal subtotal gastrectomy is performed, while D2 lymph node dissection is widely accepted as the standard approach to optimize oncological outcomes. The disease is categorized histologically using the Lauren and World Health Organization systems, whereas tumors involving the esophagogastric junction are classified according to the Siewert scheme. For very early-stage cases, minimally invasive procedures such as endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are utilized, while staging laparoscopy plays a critical role in detecting peritoneal metastasis. Recent clinical trials demonstrate that laparoscopic gastrectomy offers advantages such as reduced blood loss and lower postoperative complication rates compared to open surgery, achieving comparable long-term survival rates. Following resection, various reconstructive techniques—including Roux-en-Y esophagojejunostomy, Loop esophagojejunostomy with Braun anastomosis, and Jejunal J-pouch Roux-en-Y reconstruction—are implemented to restore digestive continuity and improve the patient's post-operative quality of life.
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