Results of extended pancreatoduodenal resections for malignant neoplasms of the pancreatobiliary zone in conditions of cholemia

Abstract

The question of the expediency of extended pancreatoduodenal resections performing, even despite the results of many multicenter trials, remains the subject of debates. Purpose- to identify and analyze the differences in the course of the postoperative period in patients after extended and after standard pancreaticoduodenal resections. Materials and methods. The results of surgical treatment of 101 patients with malignant neoplasms of the pancreatobiliary zone, complicated by the syndrome of mechanical jaundice, were analyzed. Depending on the volume of lymphodissection, the patients were divided into two groups. 33 (32.7%) patients who underwent an extended variant of pancreaticoduodenal resection made up the main group; the comparison group included 68 (67.3%) patients who underwent standard pancreatoduodenal resection. Results. Extended pancreaticoduodenal resections were accompanied by slightly greater intraoperative blood loss compared to standard interventions, but statistical confirmation of this advantage was not found – (522±165) ml versus (468±124) ml (p>0.05). Under the conditions of the occurrence of lymphorrhea, the average flow of lymph through drains after extended pancreaticoduodenal resections was (512±26) ml/day, which was 46.2% higher than the average amount of lymph through drains in patients after standard interventions ((236±31) ml/day), which was statistically confirmed (p<0.05). The development of secretory diarrhea lasting more than 2 weeks, as a complication of extended pancreatoduodenal resection, was noted in 7 (21.2%) patients, but after standard resection – only in 3 (4.4%) patients (p<0.05). Inability of pancreaticodigestive anastomosis due to necrosis of the pancreatic stump complicated the course of the postoperative period in 9 (13.2%) patients after standard pancreaticoduodenal resection, while after extended – in 4 (12.1%) patients. Mortality after standard pancreaticoduodenal resection was 7.4% (5 patients), after extended – 6.1% (2 patients). Conclusions. The obtained results indicate the need for more careful visualization of the condition of patients at the preoperative stage, taking into account the local intraoperative situation, under the conditions of planning the performance of pancreaticoduodenal resection with extended lymph nodes dissection. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.