Surgical Treatment Of Pancreatic Cancer Research Articles

Interpretation of the surgical treatment of pancreatic cancer of the 2024 edition of the NCCN guidelines

Pancreatic cancer is a highly malignant tumor in the digestive system, and radical surgery is the only possible means to cure pancreatic cancer at present. In the past decade, pancreatic surgery has been developing rapidly, with various new technologies and concepts emerging, among which the use of minimally invasive techniques and the popularization of neoadjuvant therapy concepts are the most notable. At the same time, the surgical treatment of pancreatic cancer still has a long way to go, and many problems need to be solved urgently. This article introduces the surgical treatment of pancreatic cancer in the 2024 edition of the NCCN guidelines, focusing on minimally invasive and open surgical treatments, expanded lymph node dissection, combined vascular resection and reconstruction, surgical treatment of pancreatic neck cancer and neoadjuvant therapy, and briefly discussing the unresolved issues.

Abdominal aortic calcification volume as a preoperative prognostic predictor for pancreatic cancer.

Atherosclerosis and cancer may progress through common pathological factors. This study was performed to investigate the association between the abdominal aortic calcification (AAC) volume and outcomes following surgical treatment for pancreatic cancer. The subjects of this retrospective study were 194 patients who underwent pancreatic cancer surgery between 2007 and 2020. The AAC volume was assessed through routine preoperative computed tomography. Univariate and multivariate analyses were performed to evaluate the impact of the AAC volume on oncological outcomes. A higher AAC volume (≥ 312 mm3) was identified in 66 (34%) patients, who were significantly older and had a higher prevalence of diabetes and sarcopenia. Univariate analysis revealed several risk factors for overall survival (OS), including male sex, an AAC volume ≥ 312 mm3, elevated carbohydrate antigen 19-9, prolonged operation time, increased intraoperative bleeding, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy. Multivariate analysis identified an AAC volume ≥ 312 mm3, prolonged operation time, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy as independent OS risk factors. The OS rate was significantly lower in the high AAC group than in the low AAC group. The AAC volume may serve as a preoperative prognostic indicator for patients with pancreatic cancer.

Novel concepts for surgical treatment of pancreatic cancer

Novel concepts for surgical treatment of pancreatic cancer

Pancreatic cancer surgery — experience of one medical center

BACKGROUND: This article offers detailed information about the surgical treatment of pancreatic cancer, based on the experience of the abdominal department of Samara Regional Clinical Oncological Dispensary (Samara, Russian Federation). This allows readers to familiarize themselves with the achievements and innovations in this field, to get information about constantly improving surgical methods and their effectiveness. Such information can help not only patients, but also medical professionals, including surgeons, to improve the quality and effectiveness of operations. The article also includes an overview of the main methods of diagnosing pancreatic cancer, which can help specialists identify the disease at an early stage and improve their working methods. It provides up-to-date information on the diagnosis, treatment and prognosis of pancreatic cancer, which can help improve treatment outcomes and prolong the survival of patients suffering from this disease.
 AIM: Analysis of the state of oncological care for patients with pancreatic cancer in the Samara region over the past 5 years.
 METHODS: The results of treatment of 236 patients with pancreatic cancer operated in the department of abdominal oncology of the Samara Regional Clinical Oncology Dispensary in the period from 2018 were studied.
 RESULTS: According to the results of treatment, pancreatic cancer stage IA was established in 9.74% of patients (n=23), stage IV — in 5.89% (n=14), stage IIA — 12.71% (n=30), stage IIB — in 12.71% (n=30); stage III — in 23.30% (n=55), stage IV — in 35.59% (n=84) of patients. Of the 76 patients with initially unresectable tumors, 12 received neoadjuvant chemotherapy according to the FOLFIRINOX scheme, which allowed them to perform radical surgery. The average age of the patients was 62.2 years. The overall survival rate in the entire group of patients was 20 months. It is interesting to note that in the group of patients with stage III, the 1-year survival rate was 20.53%, which is lower than in the group of patients with stage IV (25.59%). Most likely, this is due to postoperative complications and mortality in patients with stage III who underwent radical treatment (while patients with stage IV underwent gentle palliative surgery).
 CONCLUSIONS: Pancreatic cancer is a complex disease that requires an interdisciplinary approach to achieve the necessary diagnosis and develop optimal treatment tactics. Radical surgery is disabling, but remains the only treatment option for pancreatic cancer, which determines the patient’s life prognosis. The results of gastropancreatoduodenal resection are characterized by a significant frequency of postoperative complications (34.38%), with a high rate of postoperative mortality (20.93%). Unsatisfactory results of surgical treatment of pancreatic cancer indicate the need to develop more effective methods of complex treatment. The lack of verification of pancreatic cancer at the prehospital stage in the majority of patients (84.6%) does not allow chemotherapy treatment in the neoadjuvant mode for locally advanced forms, which dooms patients to diagnostic surgery. As a result, valuable time is lost, which calls into question the well-being of such patients. The development of new, more effective diagnostic methods at the outpatient stage will solve this problem.

Magnetic resonance imaging relevance in diagnosis and prognosis of early postoperative period following pancreatic cancer surgical treatment

Purpose of the study. Improvement of the prognostic outcomes for the pancreatic fistula development in surgical treatment for pancreatic cancer by implementation of new diagnostic algorithms for magnetic resonance imaging (MRI) assessment of supposed pancreatic stump.Materials and methods. We performed a retrospective analysis of MRI results of 1136 patients from the medical data base of National Medical Research Centre for Oncology for 2009–2020. An original scanning technique, trans- and cross-pancreatic imaging and MR spectroscopy of the pancreas in patients with pancreatic cancer, was developed and applied. Preoperative examinations were compared retrospectively: a standard MRI protocol without anatomical orientation of the series; MRI protocol using the developed technology.Results. 717 patients were diagnosed with advanced pancreatic cancer. Lymph nodes were affected in 302 patients among 419 patients with radical surgeries. All cases were confirmed morphologically. In the group of 419 patients with pancreatic resections, based on the analysis of morphological and clinical data and preoperative MRI data, we developed an original preoperative scale for assessing the risk of pancreatic fistula development and compared its accuracy with other intraoperative scales, FRS and modified FRS. Lactate and lipid complex were selected from a wide range of metabolites. The surgical protocols and results of histological examination of the surgical material were used to prove the accuracy of the study. The overall accuracy of the technique in predicting fistula development was 97.5 %. New visual predictors («domino» and «white on white» symptoms) based on MRI data were used to improve the scale accuracy.Conclusion. The developed method of using a modified scale for risk assessment of pancreatic fistula development allows predicting the onset of early postoperative complications already at the preoperative stage. When comparing the calculated risks of pancreatic fistula according to the developed scale with the results by the known scales (FRS and modified FRS), statistical analysis showed a significant difference for the better when compared with FRS (p = 0.0477), and a tendency when compared with modified FRS (p = 0.0544).

Perioperative pain management in opioid-dependent patient with chronic pain: Current approaches and hidden dangers. Clinical case

Severe chronic pain syndrome with high requirement for opioids is frequently complicated by opioid tolerance, hyperalgesia, and other side effects. Special complications occur during anesthesia for high-injury surgical interventions and in the postoperative period. Perioperative pain management in these patients requires planning, multimodal approach, combination methods, and prevention of complications including specific complications. This article describes a case of successful surgical treatment of pancreatic cancer in a patient with severe chronic pain syndrome, opioid tolerance, and hyperalgesia. Perioperative period was complicated by high requirement for epidural pain management and use of adjuvants, acute strangulating intestinal obstruction on day 6 of the postoperative period. The authors had to differentiate between pain syndrome and abstinence multiple times and encountered the problem of tachyphylaxis to local anesthetics. Due to thought-out and flexible system of combination multimodal pain management, pain syndrome was relieved, and the patient was discharged in satisfactory condition without the need for opioids.

Surgical Treatment of Pancreatic Cancer: Currently Debated Topics on Vascular Resection.

Vascular resections involving the superior mesenteric and portal veins (SMV-PV), celiac axis (CA), superior mesenteric artery (SMA) and hepatic artery (HA) have multiplied in recent years, raising the resection rate for pancreatic cancer (PDAC) and the related morbidity and mortality rates. While resection is generally accepted for resectable SMV-PV, the usefulness of associated arterial resection in borderline resectable (BRPC) and locally-advanced PDAC (LAPC) is much debated. Careful selection of splenic vein reconstruction is very important to prevent left-sided portal hypertension (LSPH). During distal pancreatectomy (DP), CA and common HA resection is largely accepted, while there is debate on the value of SMA and proper HA resection and reconstruction. Their resection is useless according to several reviews and meta-analyses, and some international societies, although some high-volume centers have reported good results. Short- and long-term reconstructed vessel patency varies with the type of reconstruction, the material used, and the surgeon's experience. Laparoscopic and robotic pancreaticoduodenectomy and DP are generally accepted if done by surgeons performing at least 10 such procedures annually. The usefulness of associated vascular resection remains highly controversial. Surgeons need to complete numerous minimally-invasive procedures to overcome the learning curve, and prevent an increase in complications and surgical mortality. Higher resectability rates and satisfactory long-term results have been reported after neoadjuvant therapy (NAT) for BRPC and LAPC requiring vascular resection. It is essential to select the most appropriate NAT for a given patient and to assess PDAC resectability preoperatively.

The comparative analysis of transradial and transfemoral vascular approaches for chemoembolization of pancreatic cancer

BACKGROUND: Pancreatic cancer is one of the most aggressive malignant neoplasms, and the results of treatment of which remain extremely unsatisfactory. One of the methods to increase the effectiveness of surgical treatment of pancreatic cancer is selective oil chemoembolization of the pancreatic arteries. Transfemoral access is typically used as a vascular access during this type of intervention, in which complications from the vascular access are often observed.
 AIM: This study aimed to analyze the results of the use of transradial and transfemoral approaches for chemoembolization of pancreatic cancer.
 MATERIALS AND METHODS: We analyzed the results of chemoembolization of pancreatic arteries in 32 patients with pancreatic cancer. Transfemoral access was used in 16 (50%) patients and transradial access in 16 (50%) patients. According to the main clinical and anamnestic data, both groups were comparable. The endpoints of the study were technical success and complication rate of chemoembolization, total duration of the procedure, time needed for catheterization of the target artery, radiation exposure, and degree of discomfort for the patient.
 RESULTS: Chemoembolization of pancreatic arteries was successfully performed in 100% of patients in both groups. Major vascular complications were observed in three (18.8%) patients in the transfemoral access group and in one (6.3%) in the transradial access group (p=0.6). The total duration of the procedure and the time needed for catheterization of the target artery were 54.546.61 and 51.306.46 min (p=0.17) and 12.7 and 13.25 min (p=0.72), respectively. Radiation exposure was 0.680.10 mSv in the transfemoral access group and 0.650.10 mSv in the transradial access group (р=0.4). Transradial access was associated with a statistically significant reduction in all parameters of procedural discomfort.
 CONCLUSION: In terms of efficiency and safety of use, the transradial approach is not inferior to the traditional transfemoral approach, and in terms of patient comfort, it can be recommended as a priority for chemoembolization of the pancreatic arteries.

Trends in the surgical treatment for pancreatic cancer in the last 30 years.

Pancreatic cancer has the poorest prognosis among digestive cancers. During the 1990s, the 5-year survival rate of surgical patients with pancreatic cancer was 14% in Japan. However, survival rates have increased to 40% in the 2020s due to the refinement of surgical procedures and the introduction of perioperative chemotherapy. Several pivotal randomized controlled trials have played an indispensable role to establish each standard treatment strategy. Resectability of pancreatic cancer can be classified into resectable, borderline resectable, and unresectable based on the anatomic configuration, and multidisciplinary treatment strategies for each classification have been revised rapidly. Investigation of superior perioperative adjuvant treatments for resectable and borderline resectable pancreatic cancer and the establishment of optimal conversion surgery for unresectable pancreatic cancer are the progressive subjects.

Modification of prophylactic anticoagulation regimen reduces the incidence of thrombotic complications after venous reconstruction.

e16250 Background: Surgical treatment for pancreatic cancer (PC) with venous reconstruction is associated with a high risk of venous thrombosis. The purpose of this study was to analyze the dynamics of the blood fibrinolytic system in the postoperative period in PC patients after venous reconstruction. Methods: The study included patients with PC (T3N0-1M0), mean age 63 years. Patients of the main group (n = 11) underwent pancreaticoduodenal or corporocaudal resection with venous reconstruction (portal and superior mesenteric veins), mesenteric cross-clamping time 7-40 minutes (average 23 minutes). Patients of the control group (n = 11) received similar surgical treatment without venous resection. All patients received postoperative prophylactic anticoagulation: standard nadroparin 0.4 ml once a day in the control group and a modified regimen of nadroparin 0.1 ml per 10 kg of body weight per day in a low bleeding risk in the main group. Levels of tPA, uPA, PAI-1 and suPAR, and tPA-act, uPA-act, and PAI-1-act activity were determined in the blood plasma by ELISA (Technoclone, Austria; R&D Systems, USA) on days 1-3, 5-7 and 8-14 after surgery. Results: No thrombotic complications were registered in the main group during the 30-day observation period, while 2 patients (18.2%) in the control group were diagnosed with distal venous thrombosis on days 10-14. The frequency of hemorrhagic complications was similar in both groups (9.1% vs 9.1%). Levels of PAI-1 decreased by 2.4 times in both groups on days 1-3 after surgery, tPA increased by 1.7 times (p < 0.01), and tPA-act increased in the main group by 2.9 times. On days 5-7, no changes were registered in the control group, while patients of the main group showed decreased tPA-act by 3.2 times and elevated suPAR and PAI-1 by 2.2 times (p < 0.01) and PAI-1-act by 3.6 times. However, levels of PAI-1-act decreased by 2.2 times (p < 0.01) in the main group on days 8-14, and in control group PAI-1 increased by 2.4 times (р < 0.05). Thus, patients in the main group had 2.4 times higher levels of tPA on days 1-3, compared to the control group, and higher suPAR on days 5-7 (by 1.8 times, p < 0.01), PAI-1 and PAI-1-act by 2.0 times (p < 0.01), and higher tPA (by 4.4 times) on days 8-14. Conclusions: The proposed scheme of prophylactic anticoagulation showed its efficacy and safety. It activated fibrinolysis 1-3 days after surgery. Further on, we could observe signs of enhanced prothrombotic and pro-inflammatory state despite the ongoing anticoagulant therapy, which, however, was not manifested by thrombotic complications. Levels of tPA increased significantly by days 8-14 after venous reconstruction and intestinal ischemia, while inhibitor levels remained high, which can be considered a change in the balance towards activation of fibrinolysis and enhancement of anti-inflammatory processes.

Real-world study of surgical treatment of pancreatic cancer in China: annual report of China Pancreas Data Center (2016–2020)

Abstract Objective: In 2015, the Chinese Pancreatic Association of the Chinese Society of Surgery of the Chinese Medical Association launched a national multicenter online system for registration of surgical treatment of pancreatic cancer in China, called China Pancreas Data Center (CPDC). With continued effort, the CPDC has developed over time. Herein, we report the general results of the CPDC from January 2016 to January 2020 to present the real-world situation of surgical treatment of pancreatic cancer in China. Methods: The data of the CPDC from January 2016 to January 2020 were retrieved and analyzed in this real-world study, including the data on patient demographics, comorbidities, diagnostic modalities, neoadjuvant treatment, surgical procedures, postoperative complications and treatment, pathological examinations, postoperative adjuvant treatment, survival, and risk factors. Results: A total of 13,595 cases from 70 centers in 28 provinces were retrieved for analysis. This study reported the largest cohort of patients who underwent surgical treatment for pancreatic cancer in China to date. More cases were derived from the Eastern regions, among which Shanghai, Beijing, and Zhejiang ranked in the top three. The peak age of the patients ranged from 60 to 69 years. The ratio of males to females was 1.5:1. Overall, 64.3% of the tumors were located in the head and neck of the pancreas, and 35.7% in the body and tail of the pancreas. Of the patients, 23.0% underwent positron-emission tomography-computed tomography, 21.6% underwent endoscopic ultrasound, and 4.8% underwent preoperative biopsy. Two percent of the patients underwent neoadjuvant treatment, while 68.9% underwent R0 surgical resection (margin free of tumor cells). Of the latter, 78.6% of the operations were open procedures, 12.6% were laparoscopic procedures, 2.9% were robotic procedures, and 3.7% were converted to open procedures. The in-hospital mortality rate after surgery was 0.4%. The incidence of grade 2 and grade 3 postoperative pancreatic fistulas was 25.5% and 2.5%, respectively. The incidence of complications based on the Clavien-Dindo classification was 17.9% of grade II, 4.3% of grade IIIa, 1% of grade IIIb, and 0.6% of grade IV. Of the patients, 28.9% underwent postoperative adjuvant chemotherapy. The 1-year, 2-year, and 3-year overall survival of these patients were 77%, 51%, and 38%, respectively. In the 8542 patients who underwent R0 resection, the 1-year, 2-year, and 3-year overall survival and disease-free survival were 77%, 54%, and 43%, and 68%, 49%, and 41%, respectively. The factors related to the prognosis of these patients were also identified after uni- and multi-variate analyses. Conclusion: The surgical quality, safety, and long-term survival of the patients in CPDC are similar to those of international high-volume pancreatic centers. However, neoadjuvant and postoperative adjuvant chemotherapy should be improved.

Non-Woven Sheet Containing Gemcitabine: Controlled Release Complex for Pancreatic Cancer Treatment.

The 5-year survival rate for pancreatic cancer remains low, and the development of new methods for its treatment is actively underway. After the surgical treatment of pancreatic cancer, recurrence and peritoneal dissemination can be prevented by long-term local exposure to appropriate drug concentrations. We propose a novel treatment method using non-woven sheets to achieve this goal. Poly(L-lactic acid) non-woven sheets containing gemcitabine (GEM) were prepared, and GEM sustained release from this delivery system was investigated. Approximately 35% of the GEM dose was released within 30 d. For in vitro evaluation, we conducted a cell growth inhibition test using transwell assays, and significant inhibition of cell growth was observed. The antitumor effects of subcutaneously implanted GEM-containing non-woven sheets were evaluated in mice bearing subcutaneous Panc02 cells, and it was established that the sheets inhibited tumor growth for approximately 28 d. These results suggest the usefulness of GEM-containing non-woven sheets in pancreatic cancer treatment.

Surgical treatment for pancreatic cancer with liver metastasis:exploration and innovation

The prognosis of pancreatic cancer patients with liver metastasis (PCLM) is very poor and the median overall survival(OS) is less than 6 months.The current standard treatment for PCLM is systematic chemotherapy.Though the chemotherapeutic regimens are better than gemcitabine only,the OS remains dissatisfied.A lot of retrospective studies identified that surgical treatment can only offer survival benefits for highly selected rather than entire PCLM patients.The Chinese Study Group for Pancreatic Cancer (CSPAC) has initiated a multiple-center,prospective,randomized comparison clinical trial,named CSPAC-1 to identify the standard and value of surgical treatment of PCLM patients.This manuscript reviewed the current progress of surgical treatment for pancreatic cancer with liver metastasis and looked forward to opportunities and challenges in the future.

Guidelines for the diagnosis and treatment of pancreatic cancer in China(2021)

The incidence of pancreatic cancer has been rising worldwide,while its clinical diagnosis and treatment remain a great challenge. To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years, Chinese Pancreatic Surgery Association,Chinese Society of Surgery,Chinese Medical Association updated "Guidelines for the diagnosis and treatment of pancreatic cancer in China （2021）" based on the Guideline of Management of Pancreatic Cancer in China which had been published in 2014. This updated guideline was formulated after reviewing evidence-based and problem-oriented literatures published from 2015-2021,mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer,conversion strategies for locally advanced pancreatic cancer,treatment of pancreatic cancer with oligo metastasis,adjuvant and neoadjuvant therapy,standardized processing of surgical specimens and evaluation of surgical margin status,systemic treatment for unresectable pancreatic cancer,genetic testing,as well as postoperative follow up of patients with pancreatic cancer. Forty recommendation items were finally proposed based on the above issues,and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation,Assessment,Development,and Evaluation system. This guideline aims to improve the ability of clinical diagnosis and therapy,especially surgical treatment of pancreatic cancer in China,and furtherly improve the prognosis of pancreatic cancer patients.

Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)

Abstract The incidence of pancreatic cancer has been rising worldwide, and its clinical diagnosis and treatment remain a great challenge. To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years, Chinese Pancreatic Association, the Chinese Society of Surgery, Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China (2014) after reviewing evidence-based and problem-oriented literature published during 2015–2021, mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer, conversion strategies for locally advanced pancreatic cancer, treatment of pancreatic cancer with oligo metastasis, adjuvant and neoadjuvant therapy, standardized processing of surgical specimens and evaluation of surgical margin status, systemic treatment for unresectable pancreatic cancer, genetic testing, as well as postoperative follow up of patients with pancreatic cancer. Forty recommendation items were finally proposed based on the above issues, and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation, Assessment, Development, and Evaluation system. This guideline aims to standardize the clinical diagnosis and therapy, especially surgical treatment of pancreatic cancer in China, and further improve the prognosis of patients with pancreatic cancer.

Venous resections and reconstructions in surgery of pancreatic cancer

Aim. To evaluate results of venous resections in tumor infiltration of venous wall in pancreatic cancer (PC).
 Materials and Methods. The study included 74 patients with PC and tumor invasion of the wall of the mesenteric-portal system (T3 N0-1 M0). The control group included patients (n=53), receiving palliative chemotherapy. The average age of patients in the group of surgical treatment was 61.89.8 years, in the control group 63.210.1 years (р0.05), the average diameter of the tumor was 39 mm and 43 mm, respectively (р0.05). In 62 cases of the group of surgical treatment the tumor was located in the head of pancreas (P), the patients were conducted pancreaticoduodenal resection with venous resection. In the rest of cases (n=12) the tumor was located in the body of P, corporocaudal resection of P was conducted with venous resection.
 Results. In the early postoperative period 2.7% of patients developed thrombosis of the reconstruction zone, 1.4% developed bleeding. 30-Day postoperative lethality was 4.1%. Median survival in surgical treatment of PC with venous resection was higher in comparison with palliative chemotherapy: 19 months vs 13 months, р0.05. In the group of venous resection the lowest annual survival (46.2%) was noted in patients with marginal resection of the vein. No significant differences were found in the parameters of survival with use of direct venous anastomose and venous prosthetics (66.7% vs 63.2%, p0.05).
 Conclusions. Angioplastic interventions permitting to achieve microscopically complete resection of the tumor in PC with tumor infiltration of mesenteric-portal system, permit to improve survival of patients in comparison with palliative chemotherapy.

Fifty Years of Surgery for Pancreatic Cancer.

The surgical treatment of pancreatic cancer (PDAC) has seen sweeping changes during the past 5 decades. Up to the middle of the 20th century resection rates were below 5%, but the numbers of curative resections for PDAC are now continuously increasing due to improved neoadjuvant treatment concepts as well as progress in surgical techniques and perioperative management. During the same period, mortality rates after pancreatic surgery have decreased considerably and are now less than 5%. One of the most important cornerstones of reduced mortality has been the concentration of PDAC surgery in specialized centers. In addition, the management of postoperative complications has improved greatly as a result of optimized interdisciplinary teamwork. Adjuvant chemotherapy has become the reference treatment in resected PDAC, achieving significantly prolonged survival. Moreover, the concept of borderline resectable PDAC has emerged to characterize tumors with increased risk for tumor-positive resection margins or worse outcome. The best treatment strategy for borderline resectable PDAC is currently under debate, whereas neoadjuvant therapy has become established as a beneficial treatment option for patients with locally advanced PDAC, enabling conversion surgery in up to 60% of cases. This review article summarizes the principal changes in PDAC surgery during the past 50 years.

Prevention of complications of pancreatoduodenal resection in pancreatic cancer

Introduction. Over the past few decades, the incidence of pancreatic cancer has dramatically increased worldwide. Despite the high prevalence of this oncological pathology, there is currently no consensus on the expediency of performing radical reconstructive-plastic surgeries in case of malignant pancreatic tumors.
 Aim: to study the influence of reconstructive-plastic techniques of surgical treatment of pancreatic cancer on the life expectancy of patients and its quality.
 Materials and methods. Analysis of the short and long-term outcomes of surgical treatment of pancreatic cancer was conducted. In total, radical operative interventions were carried out in 32 patients, including 14 men (56.25%) and 18 women (43,75%), aged 37 to 72 (61,5±10,0) years. Pyloro-preserving pancreatoduodenal resection was performed in 20 (62.5%) patients, gastropancreatoduodenal resection — in 6 (18.8%) patients, proximal resection — in 5 (15.6%) patients, distal pancreatic resection — in 1 case (3,1%). Areflux pancreatojejunal anastomosis was formed in patients by the clinic technique.
 Results. Hospital mortality was 6.25%. More than three years after surgery, 15.6% of patients are alive; the median survival rate is 19.5±2.4 months. An assessment of the quality of life and the function of the formed pancreatojejunostomy conducted in the immediate and remote periods showed that the presence of areflux valve reliably prevents the development of pancreatic stump, providing a high level of quality of life for patients.
 Conclusions. The use of organ-preserving and organ-modulating techniques in the treatment of operable pancreatic cancer does not affect survival, but provides an acceptable level of quality of life for patients in the short and long-term perspective after surgery.

Robotic Duodenopancreatectomy

INTRODUCTION: Advanced methods of treating pancreatic cancer are being explored to minimize some of the adversities associated with traditional laparoscopy. One of the most promising procedures is robotic duodenopancreatectomy, which appears to reduce morbidity, mortality, conversion rate, hospital stay, and improve oncological results among patients. As such, the procedure is gaining popularity in several medical facilities.
 AIM: The article describes robotic duodenopancreatectomy, improved surgical treatment of pancreatic cancer that involves the use of augmented reality.
 MATERIALS AND METHODS: The study involves a systematic review of existing literature on robotic duodenopancreatectomy. A total of 16 scholarly articles, published within the past 5 years, are used to synthesize information designed to provide a conclusive summary of evidence related to robotic duodenopancreatectomy. All the materials are retrieved from two medical databases, MEDLINE and ProQuest.
 RESULTS/OUTCOME: Morbidity: The rate of morbidity associated with the procedure is relatively high, up to 40%, but slightly lower compared to open laparoscopy, which exhibits morbidity rates of approximately 75%. Mortality: There is evidence of incidences of mortality in robotic duodenopancreatectomy, ranging between 1 and 12.5%. The main cause of death associated with the procedure is post-pancreatic hemorrhage. Conversion rate: The conversion rate in robotic surgery is relatively lower compared to open laparoscopy, ranging between 0 and 37.5%. However, it can decrease to 33.3% after subsequent surgeries. Hospital stay: The procedure is associated with a shorter hospital stays (13.7–24 days) compared to open laparoscopy (25.8 days). Oncological outcomes: Robotic duodenopancreatectomy lacks clear oncological results. However, few studies have established a median overall survival of 15 months.
 CONCLUSION: Given that robotic duodenopancreatectomy reduces the rates of mortality, morbidity, conversion rate, and length of hospital stays, it appears to be an ideal treatment of pancreatic cancer.

The current surgical treatment of pancreatic cancer in China: a national wide cross-sectional study

Abstract Objective: The aim of this study is to investigate the current status of pancreatic cancer patients undoing surgical treatment in China and to find ways to improve the survival of these patients in the future. Methods: This study is a national, multicenter, cross-sectional study in China. Information regarding pancreatic cancer patients undergoing surgical treatment from 34 high-volume tertiary IIIA level hospitals was collected and analyzed from the March 1, 2016 to the February 28, 2017. Results: In total, 2200 pancreatic cancer patients were enrolled from 34 tertiary IIIA level hospitals in 16 provinces across China. The male-to-female ratio was 1.5. More than 80% of the patients were between 50 and 70 years old. The top 4 symptoms were epigastric discomfort, abdominal pain, jaundice, and weight loss. Carbohydrate antigen 19-9 and carcinoembryonic antigen were elevated in 70.9% and 27.1% of patients, respectively. A multidisciplinary team (MDT) discussion was carried out for 35.0% of patients before surgery. The proportion of minimally invasive pancreatic surgeries was approximately 20%. A total of 83.4% of the operations achieved R0 resection, and the incidence of grade 3/4 postoperative complications was 7.7%. Only 13.4% of the patients received postoperative adjuvant chemotherapy. The percentage of pathological stage I tumors was only 24.5%. Conclusion: The majority of pancreatic cancer patients undergoing surgical resection in China are in an advanced stage. The MDT consultations for pancreatic cancer have not been widely carried out. R0 resection has been achieved in most cases, with relatively low incidence of serious complications, but minimally invasive pancreatic surgery should be further promoted. The application of postoperative chemotherapy remains low. This national, multicentre, cross-sectional study comprehensively presents the current status of pancreatic cancer patients undergoing surgical treatment and shows the road to improve survival of these patients in the future.