Novosti
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This journal is indexed in Scopus |
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Year 2023 Vol. 31 No 6
SCIENTIFIC PUBLICATIONS
I.V. MIKHAILOV 1, V.A. KUDRYASHOV 2, S.L. ACHINOVICH 2, N.N. PODGORNY 2, A.P. DYATLOV 1, CH.A.A.D. WEERAKOON 1
RESULTS OF PANCREATODUODENECTOMY IN PERIAMPULAR TUMORS AND TUMORS OF ADJACENT ORGANS
EE Gomel State Medical University 1,
Gomel Regional Clinical Oncology Center 2, Gomel,
Republic of Belarus
Objective. To analyze the immediate and long-term results of pancreatoduodenectomy in periampular tumors and tumors of adjacent organs.
Material and Methods. A retrospective (case-control) study included 325 patients who underwent pancreatoduodenectomy (PD) or total pancreatoduodenectomy (TPD) for periampular tumors (PT) and tumors of adjacent organs. The analysis of the immediate and long-term results was carried out depending on the main clinical and morphological factors.
Results. Length of postoperative hospital stay of patients was 15 (13; 23) days, the frequency of postoperative complications was 41.8%. 90-day mortality was 7.7%, hospital mortality 5.5%, and in the age group over 70 years – 17.7%. The most common complication and the main cause of death was surgical infection, the main manifestation of which after PD was pancreatic fistula (25.5%), after TPD – intra-abdominal abscesses (27.3%). The incidence of delayed gastric emptying after gastric resection and pylori-preserving operations was 10.8 and 9.1%, respectively (P=0.5). After operations R0 and R2, the overall 5-year survival was 28.2±3.0 and 0%, the median survival was 20.0 (10.0; 81.0) and 8.0 (5.5; 13.0) months (P=0.0008). The overall 5-year survival rate of patients with pancreatic head cancer was 19.8±3.5%, cancer of the ampulla of Vater – 35.0±6.2%, common bile duct cancer – 59.3±12.9%, duodenal cancer - 33.6±15.7%, gastric cancer – 19.3±8.5% and colon cancer – 40.0±15.5% (P=0.02). In all nosological types, survival decreased with an increase in the stage of the disease. The overall 5-year survival rate of patients with pancreatic head cancer with ductal adenocarcinoma and neuroendocrine tumors was 14.7±3.5% and 77.8±13.9%, respectively (P<0.001). The 5-year survival rate of patients with PT, receiving preoperative biliary drainage compared to operative intervention first was 13.0±3.4 and 40.4±4.6%, respectively (P = 0.0003).
Conclusion. The immediate results of PD are characterized by a high frequency of postoperative complications. Surgical infection prevails among them. It was diagnosed in most cases as pancreatic fistula and was the main cause of deaths. The most difficult problem is the surgical treatment of patients over the age of 70. Factors of low survival in all nosological types were residual tumors, high-stage cancer and PBD. The lowest survival rate was in patients with ductal adenocarcinoma of the pancreas.
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246041, Republic of Belarus,
Gomel Meditsinskaya st., 2,
Department Oncology Gomel State
Medical University,
tel.: +375 29 734-68-60,
e-mail: igor-mikhailov-2014@yandex.ru,
Mikhailov Igor V.
Mikhailov Igor Viktorovich, PhD, Associate Professor, Head of the Department Oncology, Gomel State Medical University, Gomel, the Republic of Belarus.
https://orcid.org/0000-0002-3796-0342
Kudryashov Vadim Andreevich, Head of the Abdominal Oncology Department, Gomel Regional Clinical Oncology Dispensary, Gomel, Republic of Belarus.
https://orcid.org/0000-0002-1512-8539
Achinovich Sergey Leonidovich, PhD, Head of the Hathology Department, Gomel Regional Clinical Oncology Dispensary, Gomel, Republic of Belarus
https://orcid.org/0000-0002-0977-5581
Podgorny Nikolay Nikolaevich, Oncologist-Surgeon of the Abdominal Oncology Department, Gomel Regional Clinical Oncology Dispensary, Gomel, Republic of Belarus.
https://orcid.org/0009-0007-9083-1877
Dyatlov Alexander Petrovich, Assistant, Department of Oncology, Gomel State Medical University, Gomel, Republic of Belarus.
https://orcid.org/0000-0003-4682-2045
Virakoon Chintana Agbo Abesundara Dissanayaka, Assistant Department Oncology, Gomel State Medical University Gomel, Republic of Belarus.
https://orcid.org/0000-0002-0939-1138