The strategy of surgical treatment of patients with tumor diseases of the pancreatoduodenal zone

Abstract

Aims. To improve the results of surgical treatment of patients with tumor diseases of the pancreatoduodenal zone. Materials and methods. The cohort study included 94 patients with tumor diseases of the pancreatoduodenal zone who underwent pancreatoduodenal resection in 2014–2019. All patients belonged to the category of resectable and borderline resectable. Two groups of patients were formed. II (comparison group) — patients who received treatment in 2014–2017 (n=49). In this group of patients, the risk of developing postoperative pancreatic fistula was not calculated and the choice of the technique for the formation of pancreatoenteroanastomosis was carried out depending on the preferences of the operating surgeon. I (main group) — patients who were treated in 2018–2019 (n=45). In this group of patients, the choice of the technique for the formation of pancreatoenteroanastomosis was carried out in accordance with the developed algorithm, depending on the risk of postoperative pancreatic fistula development, and also, according to indications, a new method of reservoir terminolateral pancreatojejunostomy was used. A comparative analysis revealed the representativeness of the studied groups in terms of the main parameters (gender, age, comorbidity index, anesthetic risk, the presence of obstructive jaundice, tumor localization, stage of the disease). Results. The use of the developed algorithm led to a significant decrease in the incidence of postoperative complications from 73.4 to 37.8% (p<0.01), postoperative pancreatic fistulas from 28.6 to 6.6% (p<0.05), postoperative pancreatitis from 32.6 to 11.1% (p<0.05) and arrosive bleeding from the intervention area from 18.3 to 2.2% (p<0.05). Conclusions. The use of a differentiated algorithm for choosing the formation method made it possible to improve the immediate results of surgical treatment of patients suffering from tumor diseases of the pancreatoduodenal zone.