hepatoАнналы хирургической гепатологииAnnaly khirurgicheskoy gepatologii = Annals of HPB Surgery1995-54642408-9524НЭИКОН ИСП10.16931/10.16931/1995-5464.2024-1-81-89hepato-1094Research ArticleПОДЖЕЛУДОЧНАЯ ЖЕЛЕЗАPANCREASОтдаленные результаты комбинированного лечения при первично резектабельном раке головки поджелудочной железы у больных старше 70 летLong-term outcomes of combined treatment of primary resectable pancreatic head cancer in patients over 70 yearshttps://orcid.org/0000-0003-4848-6938ЖуковаЛ. Г.ZhukovaL. G.

Людмила Григорьевна Жукова, доктор мед. наук, профессор, член-корр. РАН, заместитель директора по онкологии

111123; шоссе Энтузиастов, д. 86; Москва

Ludmila G. Zhukova, Doct. of Sci. (Med.), Professor, Corresponding-member of the Russian Academy of Sciences, Deputy Director

111123; 86, Sh. Entuziastov; Moscow

l.zhukova@mknc.ruhttps://orcid.org/0000-0002-1935-869XИзраиловР. Е.IzrailovR. E.

Роман Евгеньевич Израилов, доктор мед. наук, руководитель отдела

отдел инновационной хирургии

111123; шоссе Энтузиастов, д. 86; Москва

Roman E. Izrailov, Doct. of Sci. (Med.), Professor, Head of the Department

Department of Innovative Surgery

111123; 86, Sh. Entuziastov; Moscow

r.izrailov@mknc.ruhttps://orcid.org/0000-0003-4691-7490СеменовН. Н.SemenovN. N.

Николай Николаевич Семенов, доктор мед. наук, ведущий научный сотрудник

отделение химиотерапии 

111123; шоссе Энтузиастов, д. 86; Москва

Nikolay N. Semenov, Doct. of Sci. (Med.), Leading Researcher

111123; 86, Sh. Entuziastov; Moscow

nn.semenov@mknc.ruhttps://orcid.org/0000-0002-4543-1811МихневичМ. В.MikhnevichM. V.

Михаил Вадимович Михневич, хирург, онколог, старший лаборант

отделение высокотехнологичной хирургии; кафедра факультетской хирургии № 2

111123; шоссе Энтузиастов, д. 86; Москва

Mikhail V. Mikhnevich, Surgeon, Oncologist, Senior Research Assistant

High-Tech Surgery Unit; Department of Faculty-Based Surgery No. 2

111123; 86, Sh. Entuziastov; Moscow

mikhnevichmikhail@gmail.comhttps://orcid.org/0000-0002-4088-8118ХатьковИ. Е.KhatkovI. E.

Игорь Евгеньевич Хатьков, доктор мед. наук, профессор, академик РАН, директор, заведующий кафедрой

кафедра факультетской хирургии № 2

111123; шоссе Энтузиастов, д. 86; Москва

Igor E. Khatkov, Doct. of Sci. (Med.), Professor, Academician of Russian Academy of Sciences, Director, Head of the Department

Department of Faculty-Based Surgery No. 2

111123; 86, Sh. Entuziastov; Moscow

i.hatkov@mknc.ruГБУЗ “Московский клинический научный центр им. А.С. Логинова” Департамента здравоохранения города МосквыРоссияMoscow Clinical Scientific Center named after A.S. LoginovRussian FederationГБУЗ “Московский клинический научный центр им. А.С. Логинова” Департамента здравоохранения города Москвы; ФГБОУ ВО МГМСУ им. А.И. Евдокимова Минздрава РоссииРоссияMoscow Clinical Scientific Center named after A.S. Loginov; A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian FederationRussian FederationГБУЗ “Московский клинический научный центр им. А.С. Логинова” Департамента здравоохранения города Москвы; ФГБОУ ВО МГМСУ им. А.И. Евдокимова Минздрава РоссииРоссияMoscow Clinical Scientific Center named after A.S. Loginov; A.I. Evdokimov Moscow State University of Medicine and Dentistry of the Ministry of Healthcare of the Russian FederationRussian Federation2024150320242918189Copyright © Жукова Л.Г., Израилов Р.Е., Семенов Н.Н., Михневич М.В., Хатьков И.Е., 20242024Жукова Л.Г., Израилов Р.Е., Семенов Н.Н., Михневич М.В., Хатьков И.Е.Zhukova L.G., Izrailov R.E., Semenov N.N., Mikhnevich M.V., Khatkov I.E.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://hepato.elpub.ru/jour/article/view/1094   Цель

   Цель. Оценка отдаленных онкологических результатов панкреатодуоденальной резекции при резектабельном раке головки поджелудочной железы у больных старше 70 лет.

   Материал и методы

   Материал и методы. При ретроспективном анализе регистра МКНЦ им. А. С. Логинова выявлено 63 пациента >70 лет с резектабельным раком головки поджелудочной железы. Этим больным в 2016–2023 гг. выполнена панкреатодуоденальная резекция. Мужчин было 35 %, медиана возраста – 75 лет. Вторая стадия диагностирована у 44,4 % больных, I стадия – у 31,7 %, III стадия – у 23,8 %. Медиана наблюдения – 34,5 мес. Анализировали влияние характеристик пациента, опухоли, периоперационных данных и способа операции на общую выживаемость.

   Результаты

   Результаты. Значимое влияние на общую выживаемость оказали проведение адъювантной химиотерапии (p = 0,005; отношение рисков (ОР) 0,28, доверительный интервал (ДИ) 0,115–0,62) и низкий уровень альбумина перед операцией (p = 0,004; ОР 0,203, ДИ 0,28–0,61). После открытой операции 56 % больных не получили адъювантную химиотерапию, после мини-инвазивной – 15,4 % (p = 0,0001).

   Заключение

   Заключение. Миниинвазивная панкреатодуоденальная резекция не ухудшает онкологические результаты лечения при резектабельном раке головки поджелудочной железы у больных ≥ 70 лет. Адъювантная химиотерапия и гипоальбуминемия до операции являются статистически значимыми факторами, влияющими на общую выживаемость. Миниинвазивные технологии позволяют назначить адъювантную химиотерапию большему числу пациентов по сравнению с открытым вмешательством.

   Aim

   Aim. To evaluate long-term oncological outcomes of pancreatoduodenectomy in resectable pancreatic head cancer in patients over 70 years of age.

   Materials and methods

   Materials and methods. A retrospective analysis of the Moscow Clinical Scientific Center registry revealed 63 patients aged > 70 years with resectable  pancreatic head cancer. In 2016–2023, these patients underwent pancreatoduodenectomy. Males accounted for 35 %, and the median age comprised 75 years. Stage II was diagnosed in 44.4 % of patients, stage I – in 31.7 %, and stage III – in 23.8 %. Median follow-up accounted for 34.5 months. The authors analyzed the effect of patient characteristics, tumor, perioperative data and method of surgery on overall survival.

   Results

   Results. Adjuvant chemotherapy (p = 0.005; HR 0.28, CI 0.115–0.62) and low preoperative albumin levels (p = 0.004; HR 0.203, CI 0.28–0.61) had a significant impact on overall survival. After open surgery, 56 % of patients did not receive adjuvant chemotherapy, after minimally invasive surgery – 15.4 % (p = 0.0001).

   Conclusion

   Conclusion. Minimally invasive pancreatoduodenectomy reveals no negative effect on the oncological outcomes of treatment for resectable pancreatic head cancer in patients ≥ 70 years old. Adjuvant chemotherapy and hypoalbuminemia prior to surgery are considered to be statistically significant factors influencing overall survival. Minimally invasive techniques enable adjuvant chemotherapy to be administered to a larger number of patients compared to open intervention.

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The authors declare that there are no conflicts of interest present.