Radical Surgical Treatment in Malignant Tumors of Pancreas
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2023-04-16 02:20
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HOTINEANU, Vladimir, HOTINEANU, Adrian, FERDOHLEB, Alexandru, CAZAC, Anatol, COTONEŢ, Alexei, BOGDAN, Valeriu, IVANCOV, Grigore, BURGOCI, Serghei, PRIPA, Valeriu. Radical Surgical Treatment in Malignant Tumors of Pancreas. In: Hepato-Gastroenterology, 2013, nr. 60(126,S.), p. 125. ISSN 0172-6390.
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Hepato-Gastroenterology
Numărul 60(126,S.) / 2013 / ISSN 0172-6390

Radical Surgical Treatment in Malignant Tumors of Pancreas


Pag. 125-125

Hotineanu Vladimir, Hotineanu Adrian, Ferdohleb Alexandru, Cazac Anatol, Cotoneţ Alexei, Bogdan Valeriu, Ivancov Grigore, Burgoci Serghei, Pripa Valeriu
 
Timofei Moșneaga Republican Clinical Hospital
 
Disponibil în IBN: 14 ianuarie 2022


Rezumat

720 patients with pancreatic tumors and tumors of periampulary region were treated in surgical clinic during the period of 2000 - 2013 years. From this group were selected 619 patients with tumors of the head of the pancreas, 95 cases with cancer of papila Water and 96 with tumors of corporocaudal region of the pancreas. The level of resectability in these cases was 33% +_1.75, p<0.001. Combination of standard CT-3D and CT angio with laparoscopy are the methods of choice in determining of resectability in these patients. Cephalic duodenumpancreatectomy was performed in 191 cases (26.5%+_1.64, p<0.001) in different techniques and in 47 cases (6.5%+_0.9, p<0.001) corporocaudal resection of pancreas. Cephalic duodenumpancreatectomy Wipple was made in 51 cases, in 121 cases was performed Child, and that lead us to the best results among all groups of patients. Cephalic duodenumpancreatectomy with preserving pylorus was possible just after infrapyloric lymph nodes explorations (19 patients). The last years the techniques of duodenumpancreatectomy considerably developed, the tumor invasion to the vena porta is not the contraindication for radical operation, the resection of vena porta could be performed for sure. In present nonresectability is determined by including in tumor process of SMA and as a result first of all SMA should be explored. We practice this techniques in our clinic since 2007. The majority of them were performed by posterior access - Pessaux; others, from mesenteric access (infracolic inferior) - Nakao and through inferior supracolic access - Hirota. For corporocaudal tumors in our clinic were made radical resections in 35 cases from 96. Methods: Diagnostical algorithm in patients with pancreatoduodenal tumors included clinical examination, biochemical labtests, tumor markers, ultrasound which determine the indications for ERCP, MRI or standard CT cholangiography or CT angio, diagnostical laparoscopy, all these permitted to increase the level of prognosis of resectability. Conclusions: 1. The treatment of patients with pancreatic cancer consists in surgical intervention in volume of cephalic duodenumpancreatectomy, the reconstructive variant - Child. 2. For early determining of intraoperative resectability of the tumor first of all should be explored SMA. The same for sure could be resected posterior-medial part of pancreas.