Ways to improve the results of surgical treatment of adenocarcinoma of the pancreatic head (the Center experience)
Abstract
Aim: to estimate the direct and long-term results of treatment ductal carcinoma of the pancreas after combination therapy.
Methods. Article presented the single center experience of 160 gastropancreatoduodenal resections (Vipple procedure) performed in a period of 2006 to December 2012. 62 of them was performed in cases of ductal adenocarcinoma of the head of the pancreas. It is shown that the annual performance in a single institution more than 20 surgeries leads to significant reduction of morbidity and mortality. Comparative assessment of the 36 extended and 26 standard gastropancreatoduodenal resections. For prevention of metastasis development in the liver in cases of true vascular invasion by the tumor after surgical therapy the protocol of loco-regional chemotherapy combined with adjyuvantny maintenance chemotherapy was offered.
Main results. Extended gastropancreatoduodenal resections (In comparison with normal gastropancreatoduodenal resections) does not cause to a significant increasing of the surgery timing, morbidity and mortality. At the same time extended gastropancreatoduodenal resections reduce the frequency of local recurrence, but did not improve overall survival. Resection of the major vessels is a factor for increasing resectability, but at same time it increases the frequency of metastasis in the liver. In cases of true vascular invasion by the tumor for prevention of the development of liver metastases authors proposed to use the protocol of locoregional chemotherapy in combination with adjuvant chemotherapy.
Keywords:carcinoma of the pancreas, gastropancreatoduodenal resection, vascular invasion, combined treatment, survival rate of the patients
Clin. Experiment. Surg. Petrovsky J. – 2013. – N 1. – С. 23–29.