* Lymphadenectomy with optimum of 29 lymph nodes retrieved associated with improved survival in advanced gastric cancer: a 25,000 patient international database study
Y. Woo i wsp. J. Am. Coll. Surg., 2017; 224: 546-555 , 

mp – omówienie

Peritonela lavage:

* “Peritoneal lavage was performed by introducing 150 ml of warm 0·9 per cent saline into the peritoneal cavity (before any biopsy). This was stimulated externally for 3 min, then aspirated from the pelvis. Cytology specimens were processed by centrifugation (3000 r.p.m.) for 5 min, followed by either direct smearing or a further cytospin, depending on sample density. Four slides were prepared for each patient, fixed in alcohol and stained using Papanicolaou methods. All slides were analysed by one of two consultant cytopathologists, and patients were deemed to have positive cytology if the slides unequivocally demonstrated the presence of free malignant cells. Indeterminate findings did not result in review by the other observer. Cytopathologists were aware of the laparoscopy findings for each patient at the time of slide analysis.” Nath, J., Moorthy, K., Taniere, P., Hallissey, M. and Alderson, D. (2008), Peritoneal lavage cytology in patients with oesophagogastric adenocarcinoma. Br J Surg, 95: 721-726. doi:10.1002/bjs.6107

*”To avoid the inflammatory cell aggregation due to peritoneal inspection and biopsy and the contamination of the ascites or peritoneal lavage fluid due to epithelial cell shedding, the ascites or peritoneal lavage fluid should be collected immediately after the creation of operation ports.

In patients with sufficient ascites, cytology may be performed after collecting ascites from the pouch of Douglas (39-41).
In patients without ascites or the volume of ascites is less than 200 mL, peritoneal lavage may be performed using 250 mL of warm normal saline in the following sequence: bilateral diaphragm, subhepatic region, greater omentum, bilateral paracolic sulcus, and pouch of Douglas.
The body position may be adjusted to Trendelenburg position or reverse Trendelenburg position. Direct rinsing of the primary tumor site should be avoided if possible. No less than 100 mL of lavage fluid should be collected from the bilateral subdiaphragmatic region, subhepatic region, and pouch of Douglas for cytological examination (42-44).” Li Z, Ji J. Application of laparoscopy in the diagnosis and treatment of gastric cancer. Annals of Translational Medicine. 2015;3(9):126. doi:10.3978/j.issn.2305-5839.2015.03.29.



  • Olga staging system for diagnosis of gastritis
  • Operative Link on Gastritis Assessment (OLGA)
  • Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM)
  • early gastric cancer (EGC) :he Japanese endoscopic gastric atrophy (EGA) classification method

Esophageal Diversion

Dostęp do szyjnej części przełyku

” The cervical incision is performed on the left sternocleidomastoid muscle. The internal jugular vein is retracted laterally and the thyroid gland anteriorly. The esophagus is approached lateral to medial. The left recurrent nerve is dissected along its cervical passage. It must be protected during this step and retracted by the hand of the assistant and not with metallic retractor not to damage it. The esophagus encircled. The right recurrent nerve is not visible. So the dissection must stay as near the right wall of the esophagus as possible. ” PR. PIERRE WAUTHY, MD, PHD

Nieszczelność zespolenia po gastrektomii