Розширені резекції в лікуванні хворих із місцеворозповсюдженими пухлинами підшлункової залози та фактори ризику виникнення післяопераційних ускладнень

Abstract

Introduction. Due to locoregional growth and early systemic spread of pancreatic adenocarcinoma, local invasion of the major vessels and adjacent organs, the presence of distant metastasis often limits tumor resectability. Extended resections of pancreatic tumors is the only opportunity for their radical treatment.Aim. To improve the results of treatment of patients with pancreatic tumors by determining of place of extended resections in the treatment of patients with locally advanced pancreatic tumors, metabolic factors of the risk of postoperative complications and mortality, and to develop methods for their prevention.Matherials and methods. In the period 2010-2017 we performed 618 resections in patients with pancreatic adenocarcinoma: distal pancreatectomy – in 139 (22,5%), pancreaticoduodenectomy – in 462 (74,8%) and total pancreatectomy– in 17 (2,7%) patients. EP were performed in 142 (23,0%) patients: pancreaticoduodenectomy – in 77 (54,2%), distal resections – in 54 (38,0%), pancreatectomy – in 11 (7,8%). 87 patient were examined using CT for sarcopenia. According to TPI sarcopenia was diagnosed in 38 (43,7%) patients, according to HUAC – in 35 (40,2%).Results and their discussion. Postoperetive complications occurred in 182 patients (38,2%) in the standard resection group and in 58 (40,8%) in the group with extended resections (????2 = 0,3 p=0,57). Mortality was 2,3%, 14 patients died: 5 (3,5%) – after extended resections and 9 (1,9%) – after standard pancreatectomy (????2 = 1,3, p=0,25). Median survival and 5-year overall survival rate were reduced in patients having extended pancreatectomy compared with those undergoing a standard resection (21 months, 26% and 28 months, 29%), ????2 = 0,15, p=0,69. The presence of sarcopenia is a reliable risk factor for postoperative complications ((????2 = 7,3, p=0,006 and ????2 = 4,47, p=0,03, p<0,05).Conclusions. Extended resection of the pancreas is possible and it can increase the number of radically operated patients. Mortality, postoperative complications, long-term results of treatment after extended resection of pancreas are comparable with standard resections. Sarcopenia can be used to predict and prevent the postoperative complications, as well as to improve the selection of patients before pancreatic resection in patients with pancreatic tumors.