THE RESULTS OF THE PANCREATODUODENECTOMY IN THE SPECIALIZED DEPARTMENT OF A GENERAL HOSPITAL

BACKGROUND Pancreatoduodenal resection (PDR) is the only radical method of treatment in patients with malignancies of the head of pancreas, terminal part of the common bile duct, duodenum, and major duodenal papilla. That is why the demand for this operation is very high.

PURPOSE OF THE STUDY To reason the possibility and necessity of PDR in a general hospital.

MATERIAL AND METHODS We studied 55 patients aged from 29 to 75 years who had undergone PDR. In 27 (49%) patients, cancer of the head of pancreas was an indication for surgery. The tumor of the terminal part of the common bile duct was diagnosed in 12 (21%) cases, major duodenal papilla — in 2 (3%) cases. Complicated chronic pancreatitis was the indication for operation in 15 (27%) cases.

RESULTS Postoperative complications were mild or average, lethal outcomes did not occur. Failure of the pancreatic-digestive anastomosis was the most common complication (8 patients). Most postoperative complications have been cured by mini invasive methods.

CONCLUSION PDR is possible, and in many cases advisable to be performed in a multidisciplinary institution, with relevant experience and technical equipment, as it provides much greater possibilities of treatment for both surgical and non-surgical complications.

1. Baychorov E.Kh., Novodvorskiy S.A., Khatsiev B.B., et al. Pankreatikogastroanastomoz pri operatsii pankreatoduodenal’noy rezektsii [Pancreatogastroanastomosis during the operation pancreatoduodenal resection]. Khirurgiya. 2012; 6: 19–23. (In Russian).

2. Shatveryan G.A. Pankreatoduodenal’naya rezektsiya v lechenii raka golovki podzheludochnoy zhelezy i periampulyarnoy zony: avtoref. dis… dra med. nauk [Pancreatoduodenal resection in the treatment of cancer of the pancreatic head and periampullary area: Dr. med. sci. diss. synopsis]. Moscow, 2006. 44 p. (In Russian).

3. Gorodnov S.V., Nabegaev A.I., Tyurina T.M., et al. Opyt lecheniya mekhanicheskoy zheltukhi pri opukholevoy patologii pankreatoduodenal’noy zony [Experience in the treatment of obstructive jaundice in the tumor pathology pancreatoduodenal zone]. Modnikovskie chteniya: VII Ros. nauchno-prakt. konf. s mezhdunarod. uchastiem: Onkologiya segodnya: patsient, gosudarstvo, meditsinskoe soobshchestvo [Modnikov’s reading: VII Ros. Scient. Conf. with international. participation: Oncology today: the patient, the state, the medical community]. Ulyanovsk, October 20–21, 2011. 82–84. (In Russian).

4. Kubyshkin V.A., Vishnevskiy V.A., Buriev I.M., et al. Pankreatoduodenal’naya rezektsiya s sokhraneniem privratnika [Pancreatoduodenectomy with preservation of pylorus]. Khirurgiya. 2003; 3: 60–63. (In Russian)

5. Wenger F.A., Jacobi C.A., Haubold K., et al. Gastrointestinal quality of life after duodenopancreatectomy in pancreatic adenocarcinoma. Preliminary results of a prospective randomized study: pancreatoduodenectomy or pylorus preserving pancreatoduodenectomy. Chirurg. 1999; 70 (12): 1454–1459.

6. Davydov M.I., Aksel’ E.M., eds. Statistika zlokachestvennykh novoobrazovaniy v Rossii i stranakh SNG v 2012 g. [Statistics of malignant neoplasms in Russia and CIS countries in 2012]. Moscow, 2014. 137, 150, 153. (In Russian)

7. Patyutko Yu.I., Kotel’nikov A.G., Abgaryan M.G. et al. Rak golovki odzheludochnoy zhelezy: sovremennoe lechenie i dal’neyshie perspektivy [Cancer of the pancreas head: modern treatment and future prospects]. Vestnik khirurgicheskoy gastroenterologii. 2007; 3: 5–16.

8. Aranha G.V., Aaron J.M., Shoup M., Pickleman J. Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery. 2006; 140 (4): 561–568.

9. Paye F. The pancreatic stump after pancreatoduodenalactomy: The “Achille heel” revisited. J Visc Surg. 2010; 147 (1): e13–20.

10. Buchler M.W., Wagner M., Schmied B.M., et al. Changes in morbidity after pancreatic resection: toward the end of completion pancreatectomy. Arch Surg. 2003; 138 (12): 1310–1314.

11. Wayne M.G., Jorge I.A., Cooperman A.M. Alternative reconstruction after pancreaticoduodenectomy. World J Surg Oncol. 2008; 6: 9.

12. Tien Y.W., Lee P.H., Yang C.Y., et al. Risk factors of massive bleeding related to pancreatic leak after pancreaticoduodenectomy. J Am Coll Surg. 2005; 201 (4): 554–559.

13. Alghamdi A.A., Jawas A.M., Hart R.S. Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis. Can J Surg. 2007; 50 (6): 459–466.

14. Munoz-Bongrand N., Sauvanet A., Denys A., et al. Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg. 2004; 199 (2): 198–203.

15. Poon R.T., Lo S.H., Fong D., et al. Prevention of pancreatic leakage after pancreaticoduodenectomy. Am J Surg. 2002; 183 (1): 42–52.

16. Balzano G., Zerbi A., Cristallo M., Di Carlo V. The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg. 2005; 9(6): 837–842.

17. Rogal’ M.L., Yartsev P.A., Vodyasov A.V. Kontsepetlevoy pankreatoenteroanastomoz

18. pri pankreatoduodenal’noy rezektsii [End-to-loop Pancreatoenteroanastomosis During Pancreatoduodenectomy]. Annaly khirurgicheskoy gepatologii. 2014; 2: 14–18. (In Russian)

19. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240 (2): 205–213.

20. Bassi C., Dervenis C., Butturini G., et al. Postoperative pancrearic fistula: an international study group IISPF) definition. Surgery. 2005; 138 (1): 8–13.

21. Wente M.N., Bassi C., Dervenis C., et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142 (5): 761–768.