Ways to improve immediate results of pancreatic cancer surgical treatment

Abstract

Introduction. In Ukraine, in the structure of mortality from cancer, pancreatic cancer ranks 6th in men (5.5%), 8th in women (6.0%). In 2021, 4 035 people were diagnosed with pancreatic cancer in Ukraine, and 64% of them died during the nearest year. Of the newly diagnosed patients, 43% have stage IV disease. Morphological verification of the type of tumor was obtained only in 42% of patients, only 5.2% of patients received combined or complex treatment. The purpose of the study was to summarize the immediate results of the treatment of patients with pancreatic cancer in the clinic and to propose a way to improve them. Materials and methods. We have summarized the experience of treating of 117 patients with pancreatic cancer, who underwent radical surgery in the surgical clinic of the Transcarpathian Regional Clinical Hospital named after A. Novak, from 2000 to 2015. We used the following methods of radical surgical interventions: pancreatoduodenal resection (Whipple procedure), subtotal distal pancreatic resection, total duodenopancreatectomy. Mortality, respectively, was 19.7% after Whipple procedure, 8.3% – after distal resection, 50% – after total duodenopancreatectomy. The total mortality was 22.2%. Research results and their discussion. Surgical complications after surgical interventions directly affected the immediate results of treatment and became the main cause of death of patients. In order to improve the results of surgical interventions by reducing the number of complications in the postoperative period, we proposed our own scheme of the reconstructive stage after pancreatoduodenal resection. According to, after the resection stage, the stump of the small intestine is sutured. The jejunum is pulled through the opening in the avascular part of the mesocolon into the upper floor of the abdominal cavity, and the first gastrointestinal anastomosis is placed along the large curvature of the stomach stump in the isoperistaltic direction. Later, at a sufficient distance, a second pacreato-jejunoanastomosis of the "end-to-side" type is formed. Then, after further pulling of the loop, a single-row anastomosis of the "end-to-side" type is formed with a precise technique between the stump of the common bile duct and the intestine. The afferent and efferent loops of the small intestine also are anastomosed "side to side" below the mesocolon. According to the proposed method we operated on 37 patients. In this group pancreatojejunoanastomosis leakage developed in 2 (5.4%) of them, hepaticojejunoanastomosis leak – in 1 (2.7%) and gastrojejunoanastomosis leak – in 1 (2.7%), which according to the Fisher test was significantly less than in the group of classic method. Conclusions. Surgical complications after operations for malignant neoplasms of the pancreas in a significant number of cases lead to septic complications, severe disturbances of homeostasis and death of the patient. The reconstructive stage of operations for malignant neoplasms of the pancreas requires a perfect execution technique in order to prevent surgical complications. In the available literature, there are no standardized recommendations regarding the technique of performing the reconstructive stage, which necessitates further research in this direction.