Медицинская литература. Новинки

 

 

 

 

 

 

Отдаленные результаты и прогноз протоковой аденокарциномы головки поджелудочной железы после стандартной и расширенной панкреатодуоденальной резекции

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Цель проспективного контролируемого исследования – оценить выживаемость, факторы прогноза и установить стадию протоковой аденокарциномы головки поджелудочной железы после стандартной и расширенной пакреатодуоденальной резекций. Всего выполнено по 30 стандартных и расширенных вмешательств. Анализируемые группы были сопоставимы по полу, возрасту, дооперационной стадии заболевания, степени дифференцировки аденокарциномы, частоте поражения лимфоузлов и экстрапанкреатической периневральной инвазии. Значимо не отличались также средний размер опухоли, среднее время операции, объем кровопотери и гемотрансфузии, частота послеоперационных осложнений и летальность. После расширенной панкреатодуоденальной резекции достоверно реже отмечали уровень резекции R1 (40,0 и 17,7% соответственно; р = 0,04) и местный рецидив (59 и 15,3%). Медиана выживаемости после расширенной операции составила 12 мес, после стандартной – 10 мес. Трех и пятилетняя выживаемость отмечена только после расширенной ПДР (25 и 17%). Показана достоверно большая продолжительность жизни после расширенной ПДР при локализации опухоли в крючковидном отростке и при ее размере от 2 до 4 см. Расширение объема лимфаденэктомии при протоковой аденокарциноме головки поджелудочной железы не привело к увеличению частоты послеоперационных осложнений, летальности и общей выживаемости. В то же время расширенная ПДР позволяет более точно определить стадию заболевания, значимо уменьшить частоту резекций R1 и местного рецидива, а также увеличить продолжительность жизни у определенной категории больных.

Ключевые слова:
протоковая аденокарцинома, панкреатодуоденальная резекция, факторы прогноза, выживаемость.

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Remote Results and Prognosis in Pancreatic Head Ductal Cancer Patients after Standard and Extended Pancreatectomy

The aim of the prospective controlled study was to estimate prognostic factors and grading preciseness of the pancreatic head ductal adenocarcinoma after standard and extended pancreatectomy. Overall 30 standard and extended pancreatectomies were carried out. Gender, age preoperative tumor grade, grade of adenocarcinoma differentiation, lymph node lesion and extrapancreatic invation rate in analyzed groups were comparable. No significant difference was in mean tumor size, surgery mean duration, bloodloss and haemotransfussion, morbidity and mortality rate. R1 level of resection (40.0 and 17.7%, correspondingly; р = 0.04) and local relapse rate (59.0 и 15.3%) was significantly lower after extended pancreatectomy Survival median after extended procedure came to 12 months and after standard – 10 months. 3-year and 5-year survival (25.0 и 17%) was noted only after extended pancreatectomy. Significantly longer life duration was displayed after extended pancreatectomy in cases of tumor location in uncinate processus and its size of 2-4 cm. Lyphadenectomy volume extension in cases of pancreatic head ductal adenocarcinoma did not lead to growing morbidity, mortality or life duration. At the same time extended pancreatectomy enables more precise determination of the disease grade, significantly lowers R1 level resection level and rate of relapse and increases life duration in certain category of patients.

Keywords:
ductal adenocarcinoma, pancreatectomy, prognostic factors, survival.