Aspectele tratamentului radical al tumorilor pancreatoduodenale

Abstract

În perioada anilor 2000-2011 în clinica chirurgie nr.2 USMF ”N.Testemițanu” au fost spitalizați 560 pacienți cu tumori pancreatoduodenale. Din acest lot au fost selectaţi 420 bolnavi de cancer de cap de pancreas, 79 de cancer PDM și 61 cazuri de tumori corporocaudale pancreatice. Rata rezecabilităţii în această grupă de pacienţi a fost de 30,6 ± 4,4%, (p < 0,001). Combinaţia dintre TC spiralată în regim standard şi angiografic cu laparoscopia este metoda de elecţie în aprecierea rezecabilităţii în cazurile noastre. La această grupă de pacienţi a fost efectuate 146 (26,1±2,4, p < 0,001) duodenpancreatectomii în diferite variante tehnice şi 26 (4,5 ± 2,0, p < 0,05) rezecţii corporocaudală de pancreas Duodenpancreatectomia clasică tip Whipple clasică am efectuat-o la 51 pacienți. Varianta de reconstrucţie care a asigurat cele mai bune rezultate postoperatorii, în lotul nostru de studiu, a fost duodenpancreatectomia cu varianta reconstrucția tip Child, pe care am efecuat-o la 76 de bolnavi. Varianta tehnică de duodenpancreatectomie cefalică cu prezervarea pilorului a fost posibilă numai după examenul extemporaneu din limfonodulii infrapilorici este obligatorie (19 pacienți). Varianta tehnica care am folosit-o la în anii 2007-2010 bolnavi din lotul de studiu a fost duodenpancreatectomia cefacică prin abord posterior. Pentru tumorile corporocaudale am efectuat rezecții radicale în 26 din 60 de cazuri tratate la noi în clinică. Concluzii: 1.algoritmul diagnostic al pacientului cu tumori pancreatoduodenale va include consecutiv şi obligatoriu analiza clinică, biochimică, determinarea markerilor tumorali; echografia ca metodă de scrining, care concretizează indicaţiile pentru CPGRE sau colangiografie prin RMN sau TC în regim standard și angiografic, și laparoscopie diagnostică care împreună măresc rata rezecabilității. 2.Tratamentul pacienţilor cu cancer pancreatic necesită tratament chirurgical specializat în volum de: duodenpancretectomie cefalică, varianta de reconstrucție Child cu abord posterior, ca intervenţie radicală sau rezecții corporocaudale de pancreas. During the period 2000-2011 there were 560 patients with pancreaticoduodenal tumors hospitalized in the Surgery Clinic No. 2 of the State Medical and Pharmaceutical University „Nicolae Testemitanu”. From this group we selected 420 patients with pancreatic head cancer, 79 cases of major duodenal papilla cancer and 61 cases of corporocaudal pancreatic tumors. The rate of resectability in these patients was 30.6 ± 4.4% (p <0.001). The combination of spiral CT in standard and angiographic mode with laparoscopy is the method of choice in assessing the resectability in our cases. There were 146 (26.1 ± 2.4, p <0.001) duodenopancreatectomies in different technical variants and 26 (4.5 ± 2.0, p <0.05) pancreatic corporocaudal resections performed in this group of patients. We performed classical Whipple duodenopancreatectomia in 51 patients. Duodenopancreatectomia in Child reconstruction variant was the reconstruction variant which provided the best postoperative results in our study group. We have performed it in 76 patients. The technical variant of cephalic duodenopancreatectomy with the preservation of the pylorus was possible only after mandatory extemporaneous examination of infrapylorical lymph nodes (19 patients). The technical variant we practiced in the years 2007-2010 in patients from the study group was cephalic duodenopancreatectomy by posterior approach. We performed radical resections for corporocaudal tumors in 26 of 60 cases, which were treated in our clinic. Conclusions: 1.Diagnostic algorithm in patients with pancreaticoduodenal tumors will include consecutive and mandatory performing of clinical examination, blood biochemistry, tumor markers analysis; ultrasound investigation as a method of screening that clarifies the indications for ERCPG or MRI or CT cholangiography in standard or angiography mode, and diagnostic laparoscopy, which together increase the rate of resectability. 2.The treatment of patients with pancreatic cancer requires specialized surgical treatment in the volume of: cephalic duodenopancreatectomy, reconstructive version Child with posterior approach as radical intervention or corporocaudal pancreatic resections.

During the period 2000-2011 there were 560 patients with pancreaticoduodenal tumors hospitalized in the Surgery Clinic No. 2 of the State Medical and Pharmaceutical University „Nicolae Testemitanu”. From this group, we selected 420 patients with pancreatic head cancer, 79 cases of major duodenal papilla cancer, and 61 cases of corporocaudal pancreatic tumors. The rate of resectability in these patients was 30.6 ± 4.4% (p <0.001). The combination of spiral CT in standard and angiographic mode with laparoscopy is the method of choice in assessing the resectability in our cases. There were 146 (26.1 ± 2.4, p <0.001) duodenopancreatectomies in different technical variants and 26 (4.5 ± 2.0, p <0.05) pancreatic corporocaudal resections performed in this group of patients. We performed classical Whipple duodenopancreatectomia in 51 patients. Duodenopancreatectomia in Child reconstruction variant was the reconstruction variant that provided the best postoperative results in our study group. We have performed it in 76 patients. The technical variant of cephalic duodenopancreatectomy with the preservation of the pylorus was possible only after mandatory extemporaneous examination of infrapylorical lymph nodes (19 patients). The technical variant we practiced in the years 2007-2010 in patients from the study group was cephalic duodenopancreatectomy by posterior approach. We performed radical resections for corporocaudal tumors in 26 of 60 cases, which were treated in our clinic. Conclusions: 1. A diagnostic algorithm in patients with pancreaticoduodenal tumors will include consecutive and mandatory performing of clinical examination, blood biochemistry, tumor markers analysis; ultrasound investigation as a method of screening that clarifies the indications for ERCPG or MRI or CT cholangiography in standard or angiography mode, and diagnostic laparoscopy, which together increase the rate of resectability. 2. The treatment of patients with pancreatic cancer requires specialized surgical treatment in the volume of cephalic duodenopancreatectomy, reconstructive version Child with a posterior approach as radical intervention or corporocaudal pancreatic resections.