Duodenopancreatectomii cefalice – experienţa unei echipe chirurgicale (2014-2022)

Abstract

Tumorile pancreatice beneficiaza de tratament curativ prin rezectie chirurgicala in circa 20% din cazuri, din cauza invazivitatii locoregionale sau la distanta. Chirurgia pancreatica prin multitudinea de aborduri si radicalitate vasculara se distinge ca una dintre cele mai provocatoare interventii chirurgicale. In cazul tumorilor invazive loco-regional avansul anestezic si chirurgical a dus la impingerea criteriilor de rezecabilitate dincolo de limitele obisnuite prin asocierea rezectiilor vasculare. Lucrarea de fata prezinta experienta unei singure echipe chirurgicale a spitalului Dr. I. Cantacuzino in abordarea neoplaziilor cefalopancreatice. In perioada 2014-2022, s-au practicat 162 duodenopancreatectomii cefalice, cu o rata progresiv crescuta anual, ajungand pana la 20 interventii pe an. Analizam in cadrul lucrarii rezultatele perioperatorii din duodenopancreatectomiile cefalice cu sau fara interesare vasculara, avand o rata de fistula pancreatica sub 5%. Volumul crescut de pacienți, standardizarea interventiei chirurgicale, cat si abordarea multidisciplinară au condus progresiv la rezultate asemanatoare centrelor dedicate chirurgiei pancreatice.

Tumors of the pancreatic head region are only treatable by surgical resection with curative intent in 20% of cases, because of early invasion in nearby structures or metastatic disease. As far as invasion of nearby structures is concerned, recent surgical and anesthesiological progress has pushed the usual resectabiliy boudaries, by incorporating vascular resections and reconstructions. We present the experience of a single surgical team of the Cantacuzino Clinical Hospital with managing pancreatic head tumors, including cases with vascular invasion. From 2014 to 2022, 162 pancrectico-duodenectomies were performed, of which 13 required vascular resection in order to achieve an R0 resection. The mean number of cases has grown to around 20 cases, with a POPF rate of 5%. We’ve analised the perioperative results of pancreaticoduodenectomies including the cases associating vascular resections, which are comparable to the current literature; also, the increasing number of patients and multidisciplinary approach have led to results similar to specialised centers.