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Границы операбельности при раке поджелудочной железы: что лимитирует?

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Предоперационная диагностика сопутствующих заболеваний необходима для выявления лимитирующих факторов в периоперационном периоде и правильной оценки возможностей пациента перенести предстоящее вмешательство. При наличии выраженных сопутствующих и фоновых заболеваний и, как следствие, высокой вероятности развития неблагоприятных событий необходимо разработать стратегию подготовки пациента к оперативному вмешательству и реализовать ее. Такая подготовка должна включать как медикаментозную, так и хирургическую коррекцию сопутствующих заболеваний для уменьшения возможных рисков. Таким образом, взвешенный, командный, мультидисциплинарный подход в периоперационном периоде позволяет значимо уменьшить риски и летальность у пациентов, оперируемых по поводу рака поджелудочной железы. Если мультидисциплинарной команде удается распознать и нейтрализовать лимитирующие факторы, то операбельность приближается к абсолютной, но если улучшения состояния пациента достичь не получается, то от операции следует воздержаться и применить другие методы лечения.

Ключевые слова:
поджелудочная железа, рак, хирургическое вмешательство, предоперационная подготовка, факторы риска, сопутствующие заболевания, осложнения, летальность, pancreas, cancer, surgical intervention, preoperative preparation, risk factors, concomitant diseases, complications, mortality

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Operability boundaries in pancreatic cancer: what is the limit?

Preoperative diagnosis of comorbidities is essential for identifying the limiting factors inperioperative period and correct assessment of patient’s ability to undergo surgery. Severe concomitant diseases followed by advanced risk of adverse events require development and implementation of the strategy of preoperative preparation of patient. These measuress hould include both medicamentous and surgical correction of concomitant diseases in order to reduce perioperative risks. Thus, multidisciplinary perioperative approach makes it possible to reduce significantly the risks and mortality in patients undergoing surgery for pancreatic cancer. Diagnosis and correction of limiting factors approach operability to absolute one. However, operation should be avoided or alternative approaches should be preferred if co-morbidities are significant and failed to be corrected.

Keywords:
поджелудочная железа, рак, хирургическое вмешательство, предоперационная подготовка, факторы риска, сопутствующие заболевания, осложнения, летальность, pancreas, cancer, surgical intervention, preoperative preparation, risk factors, concomitant diseases, complications, mortality