Analysis of surgical treatment complications in patients diagnosed with pancreatic cancer

Abstract

BACKGROUND: The main treatment for pancreatic cancer is surgery. Often, invasion into neighboring anatomical structures requires reconstructive intervention on adjacent vessels, aggravating the complexity of surgical intervention and its outcomes. The operation of choice for cancer of the head of the pancreas is gastropacreatoduodenal resection, and for a malignant tumor of the tail, distal resection of the pancreas with splenectomy. These operations, especially gastropacreatoduodenal resection, are characterized by a high level of complications and mortality. Complications such as destructive pancreatitis and failure of the pancreatodigestive anastomosis remain the main cause of death. In our article, we will analyze the various complications that we encountered during our practice at Samara Regional Clinical Oncological Dispensary.

AIM: Аnalysis of complications after radical surgical interventions for pancreatic cancer in the Samara Regional Clinical Oncology Dispensary.

MATERIALS AND METHODS: The results of treatment of 99 patients with prostate cancer who underwent radical surgical treatment in the department of abdominal Oncology of the Samara Regional Clinical Oncology Dispensary since 2018 were studied. Gastropancreatoduodenal resection (GPDR) was performed in 43.4% of patients (n=43), distal pancreatic resection with splenectomy (DRP) — 40.4% of patients (n=40). In two cases, total pancreatoduodenectomy with splenectomy was performed for multifocal cancer of the head, body and tail of the pancreas.

RESULTS: In the course of our study, it was revealed that 43.4% of patients underwent gastropancreatoduodenal resection, 40.4% underwent distal pancreatic resection with splenectomy, and in 2 cases total pancreatoduodenectomy with splenectomy was performed. During gastropancreatoduodenal resection, a standard volume of lymph dissection was performed. After surgery, pancreato-gastro-anastomosis was formed in some patients, while pancreatoejunoanastomosis was formed in others. In patients who underwent distal pancreatic resection, the gland was crossed at the level of the isthmus, the splenic vessels at the base, with the removal of groups of lymph nodes. Combined operations were performed in 12.12% of patients. In the postoperative period, all patients received synthetic somatostatin analogues and proteolysis inhibitors.

CONCLUSIONS: Our study analyzed 30 patients who experienced complications after radical surgery for pancreatic cancer. 8.08% of patients developed a class C pancreatic fistula, 5.05% had a pancreaticogastroanastomotic leak, 4.04% had a pancreaticoduodenal anastomotic leak, and 2.02% had a subhepatic abscess. All complications were classified as clinically significant according to the Clavien–Dindo classification of complications IIIb or higher. In all cases, laparotomy and sanitation of the abdominal cavity were required. Postoperative complications also included intra-abdominal bleeding and gastrostasis. The mortality rate was 12.02%; the causes of death were pancreatojejunostomotic failure and pulmonary embolism. Pancreatic fistula class C and intra-abdominal bleeding were the most significant complications affecting the clinical outcome. Mortality was lower in patients who underwent distal subtotal pancreatectomy. Survival was also higher in this group of patients. The group with extended-combined operations showed no deaths.

Keywords

pancreatic cancer / gastropancreatoduodenal resection / distal pancreatic resection with splenectomy / class C pancreatic fistula / aseptic fatty pancreatic necrosis

References

[1] Rasulov RI, Shelekhov AV, Man’kova TL, Neustroev VG. Extended gastropancreatoduodenectomy: detailed clinical and pathology analyses. Vestnik RONTs im. N.N. Blokhina RAMN. 2008;19(1):64–70. (In Russ).

[2] Расулов Р.И., Шелехов А.В., Манькова Т.Л., Неустроев В.Г. Расширенная гастропанкреатодуоденальная резекция: углубленный клинический и патологоанатомический анализ // Вестник РОНЦ им. Н.Н. Блохина РАМН. 2008. Т. 19, № 1. С. 64–70.

[3] Kostina YuD, Pavelets KV. Diagnosis and treatment of pancreatic cancer the current state of the problem. Medicine: Theory and Practice. 2018;3(3):16–26. (In Russ).

[4] Костина Ю.Д., Павелец К.В. Диагностика и лечение рака поджелудочной железы современное состояние проблемы // Медицина: теория и практика. 2018. Т. 3, № 3. С. 16–26.

[5] Kuchin DM. Vybor optimal’nogo sposoba formirovaniya pankreatodigestivnogo anastomoza pri gastropankreatoduodenal’noi rezektsii: Cand. Sci. (Med.) dissertation. Moscow; 2017. (In Russ).

[6] Кучин Д.М. Выбор оптимального способа формирования панкреатодигестивного анастомоза при гастропанкреатодуоденальной резекции : дис. кандидат медицинских наук. Москва, 2017.

[7] Katz MHG, Marsh R, Herman JM, et al. Borderline resectable pancreatic cancer: Need for standardization and methods for optimal clinical trial design. Annals of surgical oncology. 2013;20(8):2787–2795. doi: 10.1245/s10434-013-2886-9

[8] Katz M.H.G., Marsh R., Herman J.M., et al. Borderline resectable pancreatic cancer: Need for standardization and methods for optimal clinical trial design // Annals of surgical oncology. 2013. Vol. 20, N 8. P. 2787–2795. doi: 10.1245/s10434-013-2886-9.

[9] Egorova A.G., Orlov A.E., Somov A.N. and others. Malignant neoplasms in the Samara region in 2020-2021: a review of statistical information based on the results of processing the databases of the Samara Cancer Registry as of October 31, 2022. Indicators of morbidity, mortality, survival and health care status. – Saratov: Amirit LLC, 2022. – 392 p.

[10] Егорова А.Г., Орлов А.Е., Сомов А.Н., и др. Злокачественные новообразования в Самарской области в 2020-2021 годы: обзор статистической информации по результатам обработки базы данных Самарского ракового регистра по состоянию на 31.10.2022г. Показатели заболеваемости, смертности, выживаемости и состояния медицинской помощи. – Саратов: ООО «Амирит», 2022. – 392 с.

[11] Pancreatic cancer. Clinical Guidelines. ID 355. Approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation. 2020. Available from: https://cr.minzdrav.gov.ru/recomend/355_4 (In Russ)

[12] Клинические рекомендации — Рак поджелудочной железы. ID 355. Одобрено Научно-практическим Советом Минздрава РФ. 2020. Режим доступа: https://cr.minzdrav.gov.ru/recomend/355_4 Дата обращения: 04.06.2021

[13] National Comprehesive Cancer Network Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma. Version 1 2022.

[14] Kaprin AD, Starinskii VV, Shakhzadova AO, editors. Sostoyanie onkologicheskoi pomoshchi naseleniyu Rossii v 2021 godu. Moscow: MNIOI im. P.A. Gertsena − NMRRC of the Ministry of Health of Russia branch; 2022. (In Russ).

[15] Состояние онкологической помощи населению России в 2021 году / под ред. А.Д. Каприна, В.В. Старинского, А.О. Шахзадовой. Москва: МНИОИ им. П.А. Герцена – филиал ФГБУ «НМИЦ радиологии» Минздрава России, 2022.

Funding

Самарский областной клинический онкологический диспансерSamara regional clinical Oncology dispensary

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