Dynamical lymphadenectomy as a component of multidisciplinary approach while doing operative interventions for pancreatic cancer

Keywords: pancreatic cancer; pancreatic adenocarcinoma; pancreaticoduodenal resection; lymphadenectomy, lymphnode dissection.

Abstract

Objective. To improve the results of treatment of pancreatic cancer, using modification of volumes of lymphadenectomy and application of multidisciplinary approach.

Materials and methods. Into the investigation 16 patients, suffering a moderately differentiated (G2) adenocarcinoma of the pancreatic gland head (II stage of the disease) were included. There were 10 men and 6 women. The average age of the patients have constituted 62.4 yrs old. The patients were divided into two groups – the main and the comparative one, equally - by 8 of every group. In all the patients pancreaticoduodenal resection was done. All the patients in postoperative period have obtained gemcitabine in combination with 5-fluorouracyl. In patients of the main group a dynamical personalized intraoperative lymphadenectomy in accordance to our elaborated scheme, was performed. In patients of the comparison group lymphadenectomy was performed in accordance to the volumes adjusted, and it is called a standard one.

Results. Average duration of the operation have constituted (347 ± 48) min, lymphadenectomy – (42 ± 12) min in the main group, and (31 ± 9) in the comparison group. Average volume of the blood loss have constituted (342 ± 272) ml. Average duration of hospitalization have constituted (8.2 ± 4.3) days, general rate of postoperative complications – 24.3% in both groups. After the operation the mortality was absent.

Clinically significant lymphorrhea was observed in 3 patients in the main group, and in 5 – from the comparison group. In patients of the main group 9 ± 2 lymph nodes were excised, and in a comparative one – 13 ± 2, there were revealed 7 ± 1 (77.7%) and 9 ± 2 (60%) lymph nodes affected, accordingly. Postoperative diarrhea have occurred in 4 patients: in 3 – from comparative group, and in 1 – from the main group. Duration of the recurrence-free period in the main group have constituted (18 ± 2.3) mo, and in a comparative one – (13 ± 1.5) mo. Two years have survived 12/16 (75%) patients. In the main group one patient died, and in a comparative one - 3. The two-year survival in the main group have constituted 87.5%, and in a comparative one – 62.5%.

Conclusion. Dynamical lymphadenectomy as a component of multidisciplinary approach gives possibility to reduce the quantity of the lymph nodes excised, unaffected by the tumor, to enhance the quantity of the excised lymph nodes trustworthily affected by the tumor, to lower the morbidity rate and to prolong the duration of the recurrence free period.

Author Biographies

O. Yu. Usenko, Shalimov National Institute of Surgery and Transplantology, Kyiv

Usenko Alexandr Yuriyovich, MD, PhD, professor;
Director of the Shalimov National Institute of Surgery and Transplantology,
Head of the department of gastric and intestinal surgery;
Kyiv, 30 Heroiv Sevastopolia str
+38 (044) 454 70 50
ausenko1962@gmail.com
https://orcid.org/0000-0003-4957-4104

M. Yu. Nychytailo, Shalimov National Institute of Surgery and Transplantology, Kyiv

Nychytailo Mykhaylo Yuchimovich, MD, PhD, professor;
Shalimov National Institute of Surgery and Transplantology,
Head research of the department of pancreatic surgery, laparoscopic and reconstructive surgery of bile duct;
Kyiv, 30 Heroiv Sevastopolia str
+38 (044) 454 20 18
Shalimov-org@ukr.net
https://orcid.org/0000-0001-6193-6302

M. S. Zagriichuk, Shalimov National Institute of Surgery and Transplantology, Kyiv

Zagriichuk Mykhaylo Stepanovich, MD, PhD;
Shalimov National Institute of Surgery and Transplantology,
surgeon in department of pancreatic surgery, laparoscopic and reconstructive surgery of bile duct;
Kyiv, 30 Heroiv Sevastopolia str
+38 (044) 454 20 18
(098) 272 94 05
Shalimov-org@ukr.net
https://orcid.org/0000-0001-8051-8771

V. V. Kropelnytskyi, Shalimov National Institute of Surgery and Transplantology, Kyiv

Kropelnytskyi Vladuslav Oleksandrovich,
Shalimov National Institute of Surgery and Transplantology,
Head of patomorphology and cytology department, doctor-pathologist.
(068) 359 22 68
vlad.kropelnytskyi@gmail.com
https://orcid.org/0000-0002-6390-6219

N. E. Klochkova, Shalimov National Institute of Surgery and Transplantology, Kyiv

Klochkova Natalya Evgenievna, doctor-pathologist
patomorphology department,
Shalimov National Institute of Surgery and Transplantology,
Kyiv, 30 Heroiv Sevastopolya str, Ukraine;
(067) 698 88 85
klochkova@ukr.net
https://orcid.org/0000-0001-5646-9631

Yu. V. Nezhentseva, Shalimov National Institute of Surgery and Transplantology, Kyiv

Nezhentseva YuliaValeriivna, MD;
Shalimov National Institute of Surgery and Transplantology,
surgeon in department of pancreatic surgery, laparoscopic and reconstructive surgery of bile duct;
Kyiv, 30 Heroiv Sevastopolia str
+38 (044) 454 20 18
vvvrrr15@ukr.net
https://orcid.org/0000-0001-6391-4916

Ya V. Romaniv, Shalimov National Institute of Surgery and Transplantology, Kyiv

Romaniv Yaroslav Volodumurovich, MD,
Shalimov National Institute of Surgery and Transplantology,
anesthesiologist in anesthesiology and intensive care unit department;
Kyiv, 30 Heroiv Sevastopolia str
+38 (044) 454 20 18
Doctor0765@gmail.com t.b.te
https://orcid.org/0000-0001-7158-9631

O. O. Pidopryhora, Shalimov National Institute of Surgery and Transplantology, Kyiv

Pidopryhora Olena Oleksandrivna, MD,
Shalimov National Institute of Surgery and Transplantology,
intern surgeon in department of pancreatic surgery, laparoscopic and reconstructive surgery of bile duct;
Kyiv, 30 Heroiv Sevastopolia str
+38 (044) 454 20 18
podop-elena@ukr.net
https://orcid.org/0000-0002-1657-2973

D. M. Skrypka, Shalimov National Institute of Surgery and Transplantology, Kyiv

Skrypka Dmutro Oleksandrovich, intern surgeon
Shalimov National Institute of Surgery and Transplantology,
department of pancreatic surgery, laparoscopic and reconstructive surgery of bile duct;
Kyiv, 30 Heroiv Sevastopolia str
+38 (044) 454 20 18
(097) 066 54 74
dr.skrypka@gmail.com
https://orcid.org/0000-0001-7436-1667

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Published
2019-07-07
How to Cite
Usenko, O. Y., Nychytailo, M. Y., Zagriichuk, M. S., Kropelnytskyi, V. V., Klochkova, N. E., Nezhentseva, Y. V., Romaniv, Y. V., Pidopryhora, O. O., & Skrypka, D. M. (2019). Dynamical lymphadenectomy as a component of multidisciplinary approach while doing operative interventions for pancreatic cancer. Klinicheskaia Khirurgiia, 86(7), 42-45. https://doi.org/10.26779/2522-1396.2019.07.42
Section
General Problems of Surgery

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