Purpose. Identification of the possibilities of contrast enhancement computed tomography in evaluated the number of the acinar structures in the pancreatic parenchyma at the preoperative stage to predict the development pancreatic fistula.Material and methods. In 2016–2019, 196 pancreatoduodenectomy were performed. 86 patients were retrospectively selected. Patients were divided into 2 groups: group 1 included 16 observations with the development of clinically significant pancreatic fistula, in 2 – 70 cases without complications. According to preoperative contrast enhancement computed tomography, structure of the pancreas, pancreatic parenchyma thickness, pancreatic duct diameter, the density of the pancreas in the native phase, relative parenchyma enhancement ratio, washout coefficient, pancreas stump volume were evaluated. According histological, the number of acinar and fat cells in the section of the removed pancreas was evaluated.Results. “Soft” structure of the pancreas (r = 0.374, p = 0.000), pancreatic parenchyma thickness (r = 0.549, p = 0.000), the density of the pancreas in the native phase of the scan (r = 0.568, p = 0.000), the values relative parenchyma enhancement ratio (r = 0.63, p = 0.000), pancreas stump volume (r = 0.508, p = 0.000) positively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic duct diameter (r = −0.339, p = 0.001) negatively correlated with clinically significant pancreatic fistula and the number of acinar cells. Pancreatic fistula risk is 3.09 times higher with the number of acini more than 72.5%, sensitivity 75%, specificity 75.71%. Pancreatic fistula risk is 1.8 times higher with the density of the pancreas in the native phase over 35.5 HU sensitivity 62%, specificity 65%. Pancreatic fistula risk is 2.76 times higher with values parenchyma accumulation coefficient more than 1, sensitivity 75%, specificity 73%.Conclusions. Contrast enhancement computed tomography allows evaluating acinar index in the preoperative period to pick out the high-risk patient group to development of pancreatic fistula.

Metastases in the pancreas are rather rare tumor lesion of this organ. According to different data, the incidence of metastatic pancreatic lesions varies from 1.8 to 4% of all pancreatictumors.The article presents three clinical observations of metastases of melanoma, renal clearcell cancer, lung cancer in the pancreas. All patients were treatedusing cryosurgical methods with positive dynamics in the postoperative period.A brief review of the literature discussing metastatic lesions of the pancreas is also done, and the management treatment tactics of these patients is described.

Purpose: identification of the possibilities of computer tomography with contrast enhancement in evaluated of the degree of fibrosis and number of acinar structures in the pancreatic parenchyma at the preoperative period to predict the development of postoperative complications.Material and methods: In the department of abdominal surgery in 2016-2019, 196 pancreatoduodenal resections were performed. Retrospectively selected group of patients (49). Patients were divided into 2 groups according with the postoperative period. The postoperative period was uncomplicated in 41 (84%) cases. Сlinically significant pancreatic fistula was in 8 (16%) cases. According to preoperative computed tomography with contrast enhancement, we evaluated: the structure of the pancreas; the density of the pancreas in the native phase of the scan (HU), parenchyma accumulation coefficient; parenchyma accumulation coefficient in the venous phase; parenchyma accumulation coefficient in the excretory phase; coefficient of relative washout of contrast enhancement of parenchyma. According histological we evaluated the number of fibrosis and acinar, fat cells in the section pancreas.Results: "Soft" structure of the pancreas (r=0,747, p=0,000), parenchyma accumulation coefficient (r=0,631, p=0,000), the density of the pancreas in the native phase of the scan (r=0,568, p=0,000) positively correlated with complicated postoperative period and the number of acinar cells. Parenchyma accumulation coefficient in the excretory phase (r=0,562, p=0,000) positively correlated with the fibrosis pancreas and in the negatively correlated with the complicated postoperative period. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient greater than 1, sensitivity 75%, specificity 73%. The risk of developing pancreatic fistula is 3 times higher with values parenchyma accumulation coefficient in the excretory phase less than 0.45, sensitivity 75%, specificity 63%.Conclusions: computed tomography with contrast enhancement allows the structure pancreas, the number of fibrosis and acinar cell sat the preoperative period to pick out the high-risk patient group to the development of postoperative complications.