Surgical Treatment of Pancreatic Cancer

Aim. To improve the outcomes in patients with pancreatic cancer by improving of surgical techniques and adjuvant therapy administration.
Material and Methods. 529 pancreatic cancer patients underwent surgical treatment. Standard gastro pancreaticoduodenectomy was performed in 85 patients, extended gastropancreaticoduodenectomy – in 7 cases, modified standard gastropancreaticoduodenectomy – in 263, pancreatectomy – in 25, distal pancreatectomy – in 107, cryodestruction of еру tumor in 42 patients. 161 (33%) patients underwent simultaneous resection of great vessels. Adjuvant therapy was carried out in 335 patients.
Results. Morbidity varied from 19% after cryodestruction up to 100% after pancreatectomy, while mortality was 2% after cryodestruction and distal pancreatectomy and 12% after pancreatectomy. Modified standard pancreaticoduodenectomy (GPDR) was followed by morbidity 54% and mortality 6%. GPDR with great vessels resection had significantly higher blood loss, time of surgery, morbidity and mortality. The highest rates of survival were achieved in case of adjuvant therapy.
Herewith, adjuvant chemotherapy was associated with the most favorable survival: 5-year survival and median survival after modified standard GPDR followed by adjuvant chemotherapy were 21 ± 4% and 20 months. Independent prognostic factors of overall survival were: low differentiated tumor, histologically confirmed vascular invasion, adjuvant chemotherapy.
Conclusion. Most of patients with pancreatic cancer undergoing pancreatectomy have metastases in lymph nodes, perineural invasion, while surgery is R1 resection. So, surgery followed by adjuvant chemotherapy is needed.

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