Досвід виконання розширених панкреатодуоденальних резекцій у хворих на злоякісні новоутворення панкреатобіліарної зони, ускладнені синдромом механічної жовтяниці

Abstract

Despite the results of randomized trials, mortality and survival rates, clinical aspects of extended pancreaticoduodenal resection remain a subject of debate. Purpose - to determine the effect of the pancreaticoduodenal resection volume expanding on the results of surgical intervention. Materials and methods. The results of surgical treatment of 101 patients with malignant neoplasms of the pancreatobiliary zone, complicated by mechanical jaundice syndrome, were analyzed. Depending on the volume of lymph node dissection, patients were randomized into two cohorts. The main group included 33 (32.7%) patients who underwent an extended version of pancreatoduodenal resection; the comparison group included 68 (67.3%) patients who underwent standard pancreaticoduodenal resection. Results. Intraoperative blood loss in extended interventions somewhat exaggerated the volume of blood loss in standard ones, however, there was no statistically significant advantage (522±165) ml versus (468±124) ml (p>0.05). In patients after extended surgical interventions, the average debit of lymph through the drains was (512±26) ml/day, which was almost 46.2% higher than the average amount of lymph outflow through the drains in patients after standard ((236 ± 31) ml/day) and was statistically confirmed (p<0.05). Secretory diarrhea lasting more than 2 weeks, as a complication of extended pancreatoduodenal resection, occurred in 7 (21.2%) patients, and after the standard one - only in 3 (4.4%) (p<0.05). A life-threatening postoperative complication as failure of the pancreatodigestive anastomosis due to pancreatic necrosis of the pancreatic stump complicated the course of the postoperative period in 9 (13.2%) patients after standard interventions, while after extended interventions it was diagnosed in 4 (12.1%) patients. Mortality after standard pancreatoduodenal resection was 7.4% (5 patients), after extended resections - 6.1% (2 patients). Conclusions. On the one hand, the obtained results demonstrate more difficult conditions of extended pancreaticoduodenal resection performing, and, on the other hand, the absence of statistically significant differences with standard intervention in terms of the frequency of complications. 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.