Minimally invasive surgical treatment in advanced pancreatic cancer and chronic relapsing pancreatitis

Abstract

Introduction. The pain is one of the common and important aspects of care for pacients with pancreatic nonresecable cancer (CPN) and severe chronic relapsing pancreatitis (CPR). Material and metode. The study includes 56 (69,1%) patients with CPR and 22 (27,2%) patients with CPN - 3(3,7%) patients with extrapancreatic unresectable cancer, held during the years 2008 - 2016 in the Departament of surgery Nr.2. The patients with CPR included 49 (87,5%) men and 7 (12,5%) women, CPN -20 (90,9%) men and 2 (9,09%) women. Results. They practiced 68 (83,95%) SPLT on the left 13 (16,05%) toracoscopic splanhnicectomy (SPLT) on the right, 4 (4.94%) patients also required SPLT on the right on 8 weeks after SPLT on the left due tot he minimal therapeutic response). SPLT and endoscopic stenting of CBP were done in 15 (68,18%) cases with complicated with jaundice. The analgesic effect on short-term (<3 months) had an efficacy in 56 (100%) relapsing CPR cases and 20 (90.9%) cases of CPN. Between 3-6 months, the analgesia efficacy was maintained at 38 (67,86%) cases of relapsing CP (continuing after 6 months) and 14 (63,63%) cases, 11 (50%) cases of CPN (after 6 months). The perioperative mortality was 0. Conclusion. The main adventage of SPLT is complete exlusion or semnificative redueing of doses of opioid analgetics in treatement of CPN and CPR resestant to conservative antalgic therapy. SPLT and endoscopic stenting of main biliary tract represent minimally-invasive procedures a safe surgery in CPN of complicated with jaundice.