Improvement of immediate results of pancreaticoduodenal resection
Objective. Modification of technical methods of performance of pancreatico-duodenal resection (PDR) for improvement of immediate results of surgical treatment, reduction of postoperative morbidity and lethality.
Materials and methods. The treatment results analysis in 125 patients in the clinic of the Zaytsev Institute of General and Urgent Surgery in 2012-2018 yrs, in whom PDR was the main procedure of the treatment, have constituted the base of the investigation. There were 96 (76.8%) men, and 29 (23.2%) women. The middle age group of the patients have constituted 62.4%. Malignant tumors of the pancreatic head stages I-III in accordance of classification of American Join Committee on Cancer of the AJCC 8th were revealed in 72% patients. All the patients were examined in accordance to the standard protocol, adopted in the clinic. Gastropancreaticoduodenal resection was conducted in 66.4% patients, the pylorus-preserving PDR - in 33.6% patients. Reconstructive stage on solitary loop in accordance to Whipple method was done in 31.2% patients, on isolated loop in accordance to Roux method - in 58.4%, and in accordance to the method elaborated - in 10.4%. To enhance the pancreaticojejunoanastomosis safety we proposed several technical variants, including formation of pancreatico-jejunoanastomosis in modification “duct-mucosa” in accordance to procedure, elaborated in the clinic and applied in 20% of the patients.
Results. The postoperative complications severity was estimated in accordance to classification of Clavien-Dindo (2004), and specific complications, immediately connected with PDR, - in accordance to recommendations of experts of International Study Group of Pancreatic Surgery (ISGPS). Early postoperative complications were revealed in 37.6% patients, of them in 26.5% patients - severe. Among specific complications pancreatic fistula (58.8% patients) and postoperative gastrostasis (33.3%) have prevailed. The early (in the terms up to 30 days) postoperative lethality have constituted 13.6%.
Conclusion. The technical methods of the PDR performance, elaborated by the authors, permits to improve the immediate results of this procedure in tumoral and inflammatory diseases of the pancreatic gland head, to lower the specific complications rate and the associated lethality.
Cheung TT, Poon RTP, Chok KSH, Chan ACY, Tsang SHY, Dai WC, et al. Pancreaticoduodenectomy with vascular reconstruction for adenocarcinoma of the pancreas with borderline resectability. World J Gastroenterol 2014;20(46):17448-55. doi: 10.3748/wjg.v20.i46.17448.
Mikulić D, Bubalo T, Mrzljak A, Škrtić A, Jadrijević S, Kanižaj TF, et al. Role of total pancreatectomy in the treatment of paraduodenal pancreatitis: A case report. World J Gastrointest Surg. 2019;11(6):296-302. doi: 10.4240/wjgs.v11.i6.296.
Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB (Oxford). 2011;13(6):377-84. doi:10.1111/j.1477-2574.2011.00305.x.
Hasegawa H, Takahashi A, Kakeji Y, Ueno H, Eguchi S, Endo I, et al. Surgical outcomes of gastroenterological surgery in Japan: Report of the National Clinical Database 2011-2017. Ann Gastroenterol Surg. 2019;3(4):426-50. doi: 10.1002/ags3.12258.
Li Y, Zhou F, Zhu DM, Zhang ZX, Yang J, Yao J, et al. Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy. World J Gastroenterol 2019;25(21):2650-64. doi: 10.3748/wjg.v25.i21.2650.
Xingjun G, Feng Z, Meiwen Y, Jianxin J, Zheng H, Jun G, et al. A score model based on pancreatic steatosis and fibrosis and pancreatic duct diameter to predict postoperative pancreatic fistula after pancreatoduodenectomy. BMC Surgery 2019;19(1):75-83. https://doi.org/10.1186/s12893-019-0534-4.
Rosa F, Costamagna G, DogliettoGB, Alfieri S. Classification of nodal stations in gastric cancer. Transl Gastroenterol Hepatol. 2017;2:2-9. doi: 10.21037/tgh.2016.12.03.
Dindo D, Demartines N, Clavien PA. 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):205-13. doi:10.1097/01.sla.0000133083.54934.ae.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, MD, Adham M, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161(3):584-91. doi: https://doi.org/10.1016/j.surg.2016.11.014.
Wente MN, Veit JA, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, et al. Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20-5. doi: 10.1016/j.surg.2007.02.001.
Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, 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):761-8. doi:10.1016/j.surg.2007.05.005.
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