To our best knowledge there are no data available on postoperative morbidity and mortality rates after pancreaticoduodenectomy for a comorbidity including pancreatic head cancer and chronic food born parasitic infection caused by Opisthorchis felineus. This retrospective case-control study included 53 consecutive patients with morphologically verified pancreatic head adenocarcinoma in background of chronic opisthorchiasis who underwent pancreaticoduodenectomy at our clinical hospital from October 2007 to December 2019

Aim. To assess bactibilia in patients undergoing pancreaticoduodenectomy for periampullary cancer in background of chronic opisthorchiasis and evaluate its association with early surgical outcomes. Materials and methods. A retrospective case-control study was performed in a low volume surgical center of District Clinical Hospital of Ugra and Khanty-Mansiysk State Medical Academy. We collected the data from District Clinical Hospital between august 2007 and august 2019. Of 123 consecutive patients who underwent pancreaticoduodenectomy for periampullary malignancy, 50 (40,7%) were co-infected with Opisthorchis felineus. 37 of them presented with obstructive jaundice (74%) and preoperative biliary drainage (PBD) was performed in 33 of them (66%). In the control group of 73 patients 57 (78%) were jaundiced and 51 (70%) underwent PBD (biliary stents, hepaticojejunostomy, cholecysto-/cholangiostomy, or papillosphincterotomy). We evaluated results of bile culture in both patients with concomitant opisthorchiasis and those with periampullary cancer only and assessed early postoperative outcomes including biliary complications rate. Statistical data were analyzed in Statistica 8.0. Pearson chi-square and odd ratios were calculated for qualitative criteria. 95% confidential intervals and p-value were used to define statistical significance. Results. Co-infection with opisthorchiasis caused by O. felineus was found to be associated with positive bile culture in patients with periampullary malignancies (OR = 10,0; 95% CI 3,98-25,16; p = ,000). E. coli was seen 4.7 times more often in patients with opisthorchiasis than in patients without opisthorchiasis (95% CI 1.9-11.6 at p = 0.000). Pseudomonas aeruginosa was sown as the only infect or as part of microbial associates only in patients with concomitant opisthorchiasis (p = 0.297). Clinically active cholangitis developed 7.1 times more often in the study group (95% CI 2.9-17.3 at p = .000), and the formation of biliary fistula was 3.7 times more often than in the control group (95% CI 1, 1-13.1 at p = .027) despite standard protocols for antimicrobial prophylaxis. Additional rist factor for bactibilia was preoperative biliary drainage (p = ,000). The study revealed no significant influence of opisthorchiasis on postoperative pancreatic fistula or acute postoperative pancreatitis, undrained intraabdominal fluid collections or wound infection. Conclusion. The study suggests further epidemiologic evaluation aiming to improve local protocols of perioperative management of patients undergoing high risk pancreatic and biliary surgery.

Aim. To access overall and event-free survival rates in patients after surgical treatment of localized and locally spread pancreatic head cancer. Materials and methods. A single center observational trial was conducted at a low-volume pancreatic surgery center in Khanty-Mansiysk. Data were collected retrospectively from 2007 to 2019. Patients with resectable tumors were included into the study whose final histology showed pancreatic ductal adenocarcinoma and en-bloc resection. According to the technical facilities and actual clinical protocols all patients received surgical treatment only and were then monitored. Data on progression patterns and survival rates were collected and calculated using Kaplan-Meier survival analysis. Results. Median overall survival (OS) after R0 pancreaticoduodenectomy was 16,8 months (IQR 10,9-23,5). Median progression-free survival was 10,6 mo. (IQR 8,0-20,7). OS in jaundiced patients was 4,9 mo. shorter than in patients without jaundice at the diagnosis (р = 0,011). Patients with serum bilirubin level < 100 μmol/l lived on average 7.2 months longer (p = 0.014). Most frequent sites of primary progression were liver and peritoneum, lungs, bones, lymph nodes of the abdominal cavity / retroperitoneal space, less often metastases were found in the skin and soft tissues. In 21.4% of cases metastases were found in several organs simultaneously with most frequent combination of liver and peritoneum, liver and lungs, lungs and bones. The median survival after progression was 7.1 ± 4.8 months Conclusion. Pancreatic duct adenocarcinoma has a high potential for progression and has therefore poor prognosis. To improve long-term outcomes, it is advisable to apply additional therapeutic options perioperatively.

Aim. To establish the association between pancreatic cancer precursor lesions and chronic opisthorchiasis. Materials and methods. A single center case-control study was conducted at a low-volume pancreatic surgery center in Khanty-Mansiysk. We retrospectively collected morphological data from 47 pancreatoduodenectomies performed for pancreatic ductal adenocarcinoma. The study group included 23 cases of pancreatic ductal adenocarcinoma with concomitant chronic Opisthorchis felineus invasion which were compared to 24 controls consisting of “pure” cancer. Qualitative analysis was performed using χ2 Pearson criterion. Exact Fisher test was used for small samples. Time to progression and overall survival rates were calculated using Kaplan-Meier survival analysis. Data were collected and analyzed in Statistica 7.0. Results. PanINs were seen in 41,7% pancreata resected for ductal adenocarcinoma of the head and in 95,7% cases of pancreatic cancer in background of chronic opisthorchiasis (р = 0,000; 95% CI 3,5-268). PanIN high grade were observed only in opisthorchiasis group. In mixed pathology invasive cancer component tended to be more dedifferentiated and advanced when compared to pure cancer group (p = 0,029). Median disease free survival was 9 mo. in both groups and overall survival was 13 mo. in non-opisthorchiasis group and 15,3 mo. in opisthorchiasis group (р = 0,437). Conclusion. Chronic opisthorchiasis is associated with pancreatic intraepithelial neoplasia. Pancreatic ductal adenocarcinoma in background of opisthorchiasis with preneoplastic lesions tend to be more advanced in stage and poorly differentiated. Disease free and overall survival have no statistically significant differences in patients with and without Opisthorchis felineus invasion.