Particularities in surgical treatment of patients with cancer of the head of pancreas and large duodenal papilla

Abstract

Purpose: Determining the particularities of surgical treatment of patients with cancer of the head of pancreas and large duodenal papilla. Introduction: The pancreatic neoplasm is on the fourth place among the mortality due to neoplastic diseases, and after localization in 43% it is at the level of the pancreatic head. The diagnosis of pancreatic cancer is often established late, and surgical excision of the tumor is the radical treatment. Material and methods: The study included 45 patients were treated in 2019-2020 in RCH, of which 57,7%- men and 42,3%- women. Abdominal echo - at 55,81% was hypoechoic mass with dilated bile ducts upstream, at 44,18% - diffuse changes in the liver and pancreas and at 4,65% - hypoechoic mass in the pancreas head without dilation of the bile ducts. The presence of the tumor was confirmed on abdominal CT (Fig.1). Results: Radical surgical treatment was performed in 24,4%, but in 4,44% was determined venous vascular invasion (in 2,2% diagnosed by CT angiography and in 2,2% - intraoperatory). Radical interventions were performed by cephalic duodenopancreatectomy (Whipple procedure - 20% and Child procedure- 4,44%) (Fig.2,3,4). In 4,44% vascular resection was performed due to vascular invasion of the tumor in the portal vein. Palliative surgical treatment benefited 75,5% of the general study group, of which 42,2% underwent internal bilio-digestive bypass, 24,4% underwent endoscopic stenting of the biliary tract (Fig.5,6) and 8,88% performed external bilio-digestive bypass. Conclusions: In patients with cancer of the head of pancreas and large duodenal papilla, surgical treatment can have a radical curative, but also palliative aspect that leads to increased life expectancy and improved quality of life in these patients.