Short-Term Results after Surgical Treatment of Pancreatic Cancer - Prognostic Factors and Prerequisites for Their Improvement

Abstract

Introduction: Over the past few decades there have been a significant improvement in the results of radical surgery for pancreatic cancer as the early postoperative mortality is minimized in the major centers. However, the rate of postoperative morbidity remains relatively high. The most common surgical complications are: insufficiency of pancreatic or biliary anastomosis, the occurrence of bleeding or delayed gastric emptying. Aim: The aim of this paper is to analyze the short-term results after left and right pancreatic resections for pancreatic cancer and to determine the factors influencing their appearance, the prerequisites for reducing the complications and possibilities for preventing them. Materials and Methods: A retrospective study was performed. Between 1999 and 2015, 365 patients underwent different pancreatic resections for pancreatic cancer in the Department of General and Hepato-pancreatic Surgery of the University Hospital `Alexandrovska`. Clinicopathological material was analyzed by different statistical methods using SPSS-19. Results: 244 duodenohemipancreatectomies, 40 left subtotal pancreatectomies and 81 left hemipancreatectomies were performed. Observed mortality rate was 6.85%. Applying own modification of the prosthesis of the anastomoses with drainage type `perdue` leads to decreased rates of pancreatic anastomotic leaks - 3.28%. With regard to the early postoperative results, prognostic factors are blood loss, the values of T-Bil, D-Bil and ALP. Conclusion: Optimizing surgical technique according to the existing changes of the pancreas in the specific case is the basis of reducing of the postoperative morbidity rate. On the other hand, the implementation of adequate intensive care leads to reduction in early postoperative mortality and improvement of survival.