Dynamics of the Results of the Treatment of Resectable Pancreatic Head Cancer over a 30-Year Period

Abstract

Objective: to analyze the dynamics of the immediate and long-term results of the treatment of resectable pancreatic head cancer (PHC) for the period from 1989 to 2019. Material and methods. The retrospective analysis of 123 consecutive cases of the treatment of resectable PHC has been performed. During period I (from 1989 to 2000) 11 patients were operated, during period II (from 2001 to 2013) - 72, and period III (from 2014 to 2019) - 40 patients. The structure and frequency rate of postoperative complications, 90-day mortality and the overall survival rate (by the Kaplan-Meier method) have been assessed. Results. The frequency rate of the postoperative complications in I, II, and III periods were 63.6, 48.6, and 52.5%, mortality - 0, 5,6 and 5.0 %, respectively (P > 0.05). The most common complication and cause of death in all the cases were pancreatic fistula. The indicators of the 3-year survival in I, II, and III periods were 10.0 ± 9.5 %, 18.5 ± 4.7 % and 35.3 ± 9.6 %, the median survival - 10, 13, and 22 months, respectively (P = 0.07). Conclusion . A high frequency rate of the postoperative complications with a relatively low rate of the postoperative mortality was observed in all the analyzed periods. Pancreatic fistula prevailed in the structure of the complications and was the cause of death in all the cases. In the last period there was a clear tendency to improve the long-term results of the treatment, which may be due to more active surgical tactics, increased frequency of combined operations with the resection of vessels and proportional decrease in the share of palliative (R2) operations, standardization of the volume of lymph node dissection, an increased proportion of one-stage operations and increasing the number of patients receiving adjuvant chemotherapy.

Biliary Fistula After Pancreaticoduodenectomy

“…Частота несостоятельности гепатикоеюноанастомоза (ГЕА) после ПДР варьирует в широких пределах. Ряд исследователей считает билиарную фистулу после пдр очень редким осложнением: о ней сообщается лишь в 1-5% случаев [4,8,14,15]. Другие регистрируют несостоятельность билиодигестивного анастомоза после ПДР в 2-9% случаев [5,6,7,11,12,13,14,15].…”

“…Ряд исследователей считает билиарную фистулу после пдр очень редким осложнением: о ней сообщается лишь в 1-5% случаев [4,8,14,15]. Другие регистрируют несостоятельность билиодигестивного анастомоза после ПДР в 2-9% случаев [5,6,7,11,12,13,14,15]. Имеются данные о большей распространенности этого осложнения -до 10-24% [2,9,10,16,17] и даже более 50% [18].…”