SURGICAL TREATMENT OF THE PANCREATODUODENAL CANCER
RASULOV S.R., MUKHIDDINOV N.D., YULDOSHEV R.Z., DILSHODOV S.A., RASULOV K.S.
State Education Establishment “Institute of Postgraduate Education in Health Sphere of the Republic of Tajikistan”
SI “Republican Scientific Center of Oncology” MHSP of the RT
Study Purpose. The aim of this report is the demonstration of successful result of gastropancreatoduodenal resection (GPDR) in pancreatoduodenal cancer.
Material and Methods. The clinical materials of 5 patients with tumors of the pancreatoduodenal zone, who underwent the operation of GPDR in the period from 2015 to 2018, were studied. Of these, 1 (20%) patient was operated on for pancreatic head cancer, 3 (60%) patients were operated on for duodenal cancer and colon cancer with germination into the 12-duodenum of 1 (20%) patient. According to the prevalence of the process in a patient with pancreatic cancer there was a stage T4N1M0, in patients with duodenal cancer there were T4N0M0 (2 patients) and T4N1M0 in 1 patient, in a patient with colon cancer there was a stage T4N10M0. In all patients, the diagnosis was established on the basis of the clinic, data of x-ray examination and CT of the gastrointestinal tract, endoscopic examination of the stomach and duodenum, as well as morphological examination of biopsy material.
Results. GPDR was produced according to the standard procedure, the remote unit included the head of the pancreas, the output part of the stomach with a small omentum and the right half of the large omentum, the duodenum, the gallbladder, the common bile duct and regional lymph nodes directly adjacent to the pancreatoduodenal complex. The analysis of the immediate results showed that in the postoperative period two patients had pancreatitis, one patient showed an increase in bilirubin, which was associated with a probable swelling in the area of choledochoeunanastomosis. We have not noted any cases of anastomosis insolvency. All patients were discharged home in a satisfactory condition and are observed without signs of relapse.
Conclusion. Thus, the operation of GPDR is the only radical method of treatment of patients with malignant tumors of the pancreatoduodenal zone. Improving the methods of pre – and postoperative management of patients can significantly improve the immediate outcomes of GPDR with a decrease in its complications and mortality to a minimum.
Key words: malignant tumors of the pancreatoduodenal zone, gastropancreatoduodenal resection
1. Akhmedov S. M., Safarov B. Dzh., Saidmurodov A. S., Tabarov Z. V. Modifitsirovannaya metodika pankreatoeyunoanastomoza pri gastropankreatoduodenalnoy rezektsii [A modified method of pancreatic jejuno anastomosis during gastropancreatoduodenal resection]. Vestnik Akademii meditsinskikh nauk Tadzhikistana – Herald of the Academy of Medical Sciences of Tajikistan, 2014; 1: 25-31.
2. Nedoluzhko I., Starkov Ju., Shishkin K. i dr. Hirurgicheskie metody lechenija abdominal’nogo bolevogo sindroma pri nerezektabel’nom rake podzheludochnoj zhelezy [Surgical methods of treatment of abdominal pain syndrome in non-resectable pancreatic cancer], Hirurgija. Zhurnal im. N.I. Pirogova (Surgery. Magazine them. N. And. Pirogov). 2009; 12: 53-59.
3. Patjutko Ju.I., Kudashkin N.E., Kotel’nikov A.G., Abgarjan M.G. Gastropankreatoduodenal’naja rezekcija pri zlokachestvennyh zabolevanijah, oslozhnennyh mehanicheskoj zheltuhoj [Gastropancreatoduodenal resection in malignant diseases complicated by mechanical jaundice] Hirurgija. Zhurnal im. N.I. Pirogova (Surgery. Magazine them. N. And. Pirogov). 2011; 3: 25-32.
4. Sedov A.P., Parfenov I.P., Dolzhikov A.A. i dr. Rak pankreatoduodenal’noj zony (voprosy diagnostiki i palliativnogo lechenija) [Pancreatoduodenal cancer (diagnosis and palliative care)]. Belgorod: Izd-vo BelGU(Belgorod, publishing company BelGU). 2008: 168.
5. Taziev R.M., Aglullin I.R., Didakunan F.I., Aglullin M.I., Ziganshin M.I., Safin I.R. Hirurgicheskie aspekty radikal’nogo lechenija raka biliopankreatoduodenal’noj zony [Surgical aspects of the radical treatment of cancer biliopancreatoduodenal zone], Povolzhskij onkologicheskij vestnik (of Volga region Oncology Bulletin). 2014; 4: 11-14.
6. Shul’ga I.V., Macak V.A., Vishnevskaja A.N. Analiz rezul’tatov hirurgicheskogo lechenija bol’nyh s opuholjami pankreatoduodenal’noj zony. [Analysis of the results of surgical treatment of patients with tumors of the pancreatoduodenal zone], Tihookeanskij medicinskij zhurnal (Pacific medical journal). 2013; 3: 32-34.
7. Jemal A., Siegel R., Ward E. et al. Cancer Statistics // CA Cancer J. Clin. 2009; 24: 705.
Information about authors:
Rasulov Same Rakhmonberdievich – Head of Oncology Department of ATSMU, MD; tel.+992 918 68 21 86; E-mail: firstname.lastname@example.org
Muhiddinov Nuriddin Davlatalievich – Head of Department of surgery and endovideosurgery of the Institute for postgraduate education in health care of the Republic of Tajikistan, MD
Ravshan Yuldoshev Zahidovich – Acting head of Oncology Department of the ATSMU, MD
Dilshodov Sukhrob Akhmedovich – Medical resident of the thoracoabdominal branch of the ROC, MHSP of RT
Rasulov Cashif Smeovich – Medical resident of the thoracoabdominal branch of the ROC, MHSP of RT