RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH CHRONIC PANCREATITIS AND THE RISK OF CANCER AFTER SURGICAL TREATMENT

The aim: To analyze results of surgical treatment of patients with chronic pancreatitis (CP) and to assess the causes of pancreatic cancer after surgical treatment. Materials and methods: 137 patients had duodenum-preserving resections of the pancreas. Results: In the histological examination of the pancreas it was established that the growth of fibrous tissue was registered in patients with CP., which in 19 (13.8%) almost completely replaced the acinar tissue. In the long term after the operation from 6 months to 2 years in 8 patients (5.8%) pancreatic cancer was detected. Possible causes of tumor origin were analyzed, the value of preservation of ductal hypertension, which affects the state of the duct’s epithelium, was established. The most commonly used for treatment of chronic pancreatitis the Frey surgery removed pancreatic hypertension but in two patients during the operation an insufficient volume of the pancreatic head was reconstructed. In the case of the abandonment of a large array of fibrous tissue, local hypertension was retained in the region of the ductal structures of the head, which led to the transformation of the duct epithelium. An essential factor in the problem of the preservation of pancreatic hypertension were the stenosis of pancreatic intestinal anastomoses, they arose in the long term in 4 operated patients. With stenosis of anastomosis after duodenum-preserving resection both the hypertension factor and the regeneration factor could be realized, which under certain circumstances might be significant. Conclusion: After resection of the pancreas for CP cancer was diagnosed in 5.8% of patients. The main method of preventing the risk of cancer was performing the Frey surgery for CP eliminating pancreatic hypertension in the head region of the pancreas. Diagnosis of stenosis in the late period after resection of the pancreas was an important element in the prevention of recurrence of cancer since a timely reconstructive operation could improve the drainage of duct structures.

Download Full-text

The substantiation of chronic pancreatitis surgical treatment method selection

Bulletin of Siberian Medicine ◽

10.20538/1682-0363-2007-3-43-50 ◽

2007 ◽

Vol 6 (3) ◽

pp. 43-50

Author(s):

V. A. Koubyshkin ◽

I. A. Kozlov ◽

N. I. Yashina ◽

T. V. Shevchenko

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Gastric Resection ◽

Clinical Manifestations ◽

Pancreatic Head ◽

Pain Syndrome ◽

Treatment Method ◽

Pancreas Head ◽

Resection Of The Pancreas

The experience of surgical treatment of 154 patients having chronic pancreatitis with preferential injury of the pancreas head which underwent different operative interventions: isolated resection of pancreatic head ( based upon Berger surgery - 24, Frey surgery - 39), pancreatoduodenal resection ( with gastric resection - 22, with preserved pylorus - 43) and drainage surgeries - 26 is presented in the article. The surgery of isolated resection of pancreatic head has less number of nearest unfavorable results compared with pancretoduodenal resection with preserved pylorus. Proximal resection of the pancreas the variants of which are different isolated resection of pancreatic head is superior upon surgeries with full or partly resection of the duodenum due to fast normalization of the motor-evacuation function, less rate of the intestinal reflux and portion character of duodenal evacuation. In the follow-up period after pancreatoduodenal resection, atrophic processes occur in distal areas of the pancreas which are followed by clinical manifestations of exo- and endocrinous insufficiency. The surgery of longitudinal pancreatic jejunostomy does not avoid pathologic changes in the organ head and pain syndrome.

Download Full-text

Diagnosis and treatment of biliary hypertension syndrome in chronic pancreatitis

Kazan medical journal ◽

10.17750/kmj2016-828 ◽

2016 ◽

Vol 97 (6) ◽

pp. 828-832

Author(s):

R S Shaymardanov ◽

R F Gubaev ◽

I I Khamzin ◽

I I Nuriev

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Bile Duct ◽

Biliary Tract ◽

Pancreatic Head ◽

Pancreatic Head Resection ◽

Long Term Follow Up ◽

The Common

Aim. To study the efficacy and pancreatic and biliodigestive bypass surgeries combined with or without resection of the pancreatic head in the surgical treatment of biliary hypertension syndrome in chronic pancreatitis.Methods. The analysis of surgical treatment of 87 patients with chronic pancreatitis complicated with biliary tract obstruction was performed. In 78 patients the strictures were tubular and had a length of 2-4 cm, 9 patients had «rat’s tail» shaped strictures and a length of 5-7 cm.Results. In 37 patients various biliodigestive anastomoses without intervention on the pancreas were performed. Unsatisfactory results of choledochoduodenal anastomosis in chronic pancreatitis in long-term follow-up were reported in 3 of 8 interviewed patients. The optimal variant of biliodigestive bypass in chronic pancreatitis with biliary hypertension syndrome is hepaticojejunal anastomosis. In 13 patients different interventions on biliary tract in combination with resection of pancreatic head by Frey were performed. In 13 patients with obstructive forms of chronic pancreatitis with severe pancreatic hypertension pancreaticojejunostomy without resection of the pancreatic head was performed. In the long-term follow up after these surgeries in 7 out of 10 patients the signs of biliary hypertension did not completely resolve. The best results were obtained by using draining pancreatic duct interventions with pancreatic head resection by Frey.Conclusion. In tubular pancreatogenic strictures of the common bile duct when the symptoms of biliary hypertension are severe, the method of choice is hepaticojejunal anastomosis; duodenum preserving resection of pancreatic head in chronic pancreatitis complicated with biliary hypertension should be combined with bile duct draining operations.

Download Full-text

Duodenum-Preserving Pancreatic Head Resection: Future Standard Operation in Chronic Pancreatitis

Swiss Surgery ◽

10.1024/1023-9332.6.5.254 ◽

2000 ◽

Vol 6 (5) ◽

pp. 254-258 ◽

Cited By ~ 2

Author(s):

Kondo ◽

Friess ◽

Tempia-Caliera ◽

Büchler

Keyword(s):

Chronic Pancreatitis ◽

Pain Relief ◽

Extrahepatic Bile Duct ◽

Pancreatic Head ◽

Operative Therapy ◽

Long Term Results ◽

Pancreatic Head Resection ◽

Head Region ◽

Standard Operation

As the incidence of chronic pancreatitis (CP) has risen in most industrialized countries due to increasing alcohol intake, operative therapy has gained importance, and various new operative procedures have been introduced in the past two or three decades. With pancreatic duct drainage operations, pain relief is frequently not satisfactory in long-term follow-up. Pathological studies in combination with modern molecular biology investigations, suggests that the pancreatic head is the "pacemaker" of the disease in most CP patients. Therefore, surgical procedures which aim to remove pancreatic head-related CP complications are needed in most patients. The Whipple operation, which was originally developed to treat malignancies in the pancreatic head region, follows oncological criteria and can therefore be considered surgical overtreatment in the majority of CP patients. As an alternative, the duodenum-preserving pancreatic head resection (DPPHR) was introduced by Hans Beger in 1972 to preserve the stomach, the extrahepatic bile duct and the duodenum. DPPHR is an organ-preserving surgical procedure which provides satisfactory long-term results with regard to mortality, morbidity, pain relief, weight gain and social and professional rehabilitation. Among the operations currently available, DPPHR is the best choice for a new standard operation in patients with pancreatic head-related complications.

Download Full-text

Сomparative analysis of outcomes of chronic pancreatitis surgical treatment

Siberian medical review ◽

10.20333/25000136-2021-3-80-87 ◽

2021 ◽

pp. 80-87

Author(s):

N.Yu. Sled ◽

◽

O.N. Sled ◽

N.V. Merzlikin ◽

V.F. Tskhai ◽

...

Keyword(s):

Quality Of Life ◽

Chronic Pancreatitis ◽

Surgical Treatment ◽

Pancreatic Head ◽

Long Term Results ◽

Pancreatic Cysts ◽

Combined Resection ◽

Sf 36

Aim of study. To compare short-term and long-term outcomes of surgical treatment for patients with chronic pancreatitis. Material and methods. In the period of 2002-2020, a total of 123 patients underwent surgery for treatment of complications associated with chronic pancreatitis. The patients were divided into three groups depending on the type of intervention. Patients in Group 1 underwent drainage (n=46), patients in Group 2 underwent resection (n=26) and patients in Group 3 combined resection and draining procedures (n=51). Results. After Roux-en-Y cystojejunostomy of cysts in distal parts of the pancreas(n=11), the amount of complications was lower (3 (27 [6; 61]%)) than after distal resection (n=20): 10 (50 [27; 73]%)), and the quality of life (SF-36) was higher in the long term (PSC: 55.75, MCS: 53.53 against PCS: 48.09, MCS – 49,72) after resection repair. The frequency of postoperative complications and lethality rate were higher in patients after different variants of sparing resection of pancreatic parenchyma with duct system drainage than in the group of patients treated with longitudinal cystojejunostomy. In the long term, lower lethality (5 [0; 23]%; p<0.05) and a higher level of physical (PCS – 61.31) and mental (MCS – 61.73) health were registered after the original variant of combined resection and draining intervention in comparison with traditional pancreatojejunostomy and duodenum-preserving surgery. Conclusion. Draining interventions on pancreatic cysts in distal parts of the pancreas is accompanied by better immediate and long-term results. Drainage without consideration for changes in the pancreatic head leads to a higher recurrence rate (27 [8; 55]%, р=0.013). Immediate results of the proposed combined resection and draining intervention are comparable with duodenum-preserving surgery but are characterised by lower mortality (5 [0; 23]%, р=0.06) and higher quality of life (SF-36) in the long term.

Download Full-text

Therapeutic Strategy for Chronic Pancreatitis From Long-Term Outcome, Medical Treatment Vs. Surgical Treatment

Pancreas ◽

10.1097/01.mpa.0000371194.63075.9e ◽

2010 ◽

Vol 39 (5) ◽

pp. 696

Author(s):

Kazunori Takeda ◽

Terumi Kamisawa.

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Medical Treatment ◽

Therapeutic Strategy ◽

Term Outcome ◽

Long Term Outcome

Download Full-text

Surgical treatment of chronic pancreatitis with pancreatic main duct dilatation: Long term results after head resection and duct drainage

HPB ◽

10.1080/13651820510028774 ◽

2005 ◽

Vol 7 (2) ◽

pp. 114-119 ◽

Cited By ~ 5

Author(s):

W. Schlosser ◽

A. Schwarz ◽

H.G. Beger

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Long Term Results ◽

Main Duct ◽

Duct Dilatation

Download Full-text

Short- and Long-Term Results of Surgical Treatment for Chronic Pancreatitis: A Single-Center Retrospective Experience in Japan

Gastroenterology ◽

10.1016/s0016-5085(17)34234-8 ◽

2017 ◽

Vol 152 (5) ◽

pp. S1270

Author(s):

Ippei Matsumoto ◽

Takaaki Murase ◽

Keiko Kamei ◽

Kohei Kawaguchi ◽

Masataka Matsumoto ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Surgical Treatment ◽

Long Term Results ◽

Single Center ◽

Short And Long Term

Download Full-text

Locally Advanced Pancreatic Head Cancer: Margin-Positive Resection or Bypass?

ISRN Surgery ◽

10.5402/2012/513241 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Ulrich Friedrich Wellner ◽

Frank Makowiec ◽

Dirk Bausch ◽

Jens Höppner ◽

Olivia Sick ◽

...

Keyword(s):

Pancreatic Cancer ◽

Locally Advanced ◽

Pancreatic Head ◽

Resection Margins ◽

Term Outcome ◽

Term Survival ◽

Long Term Outcome ◽

Pancreatic Head Cancer ◽

Margin Positive

Pancreatic cancer is a highly aggressive disease with poor survival. The only effective therapy offering long-term survival is complete surgical resection. In the setting of nonmetastatic disease, locally advanced tumors constitute a technical challenge to the surgeon and may result in margin-positive resection margins. Few studies have evaluated the implications of the latter in depth. The aim of this study was to compare the margin-positive situation to palliative bypass procedures and margin-negative resections in terms of perioperative and long-term outcome. By retrospective analysis of prospectively maintained data from 360 patients operated for pancreatic cancer at our institution, we provide evidence that margin-positive resection still yields a significant survival benefit over palliative bypass procedures. At the same time, perioperative severe morbidity and mortality are not significantly increased. Our observations suggest that pancreatic cancer should be resected whenever technically feasible, including, cases of locally advanced disease.

Download Full-text

Evolution of pancreatic cancer survival over the past two decades.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e15722 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e15722-e15722

Author(s):

Veronica Mariotti ◽

Ricardo Daniel Parrondo ◽

Miguel Gonzalez Velez ◽

Narjust Duma ◽

Lori Ann Leslie ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Survival ◽

Single Agent ◽

Surgical Techniques ◽

Pancreatic Head ◽

Age At Diagnosis ◽

Cancer Center ◽

The Past ◽

Significant Difference

e15722 Background: Pancreatic cancer (PaCa) is a highly lethal disease, with a 5-year overall survival (OS) rate of approximately 6%, and a median OS of only 3–6 months (m). Despite recent improvements in surgical techniques and increased use of combination chemotherapy (CT), OS remains poor. This study aims to examine the factors that led to increased OS in PaCa patients (pts) over the past two decades in a single academic institution. Methods: All medical records of pts diagnosed with PaCa at the John Theurer Cancer Center from 1990 to 2012 were reviewed, and 916 PaCa pts were included in this analysis. We compared one group of pts diagnosed from 1990 to 2003 (G1, n = 482), with a group of pts diagnosed from 2004 to 2012 (G2, n = 434) in terms of OS, demographics, tumor features and treatment (tx). Results: Median age at diagnosis was 70.5 years (range 26-96). There was no significant difference between G1 and G2 in terms of age at diagnosis, stage of disease and number of pts who received surgery. A significantly higher percentage of pts received CT in G2 compared to G1 (66.5% vs 51.0%, p = .00). Tumors of the pancreatic head were more common in G1 compared to G2 (51.8% vs 44.4% p = .02). More pts in G2 received two or more CT agents compared to G1 (49.0% vs 34.1%, p = .00). Median OS was significantly longer in G2 compared to G1 (9m vs 5m, p = .00), in pts who received CT compared to pts who did not (3m vs 9m, p = .00) and in pts who received surgery compared to pts who did not (5m vs 19m, p = .00). Pancreatic head location was associated with improved OS compared to other locations (9m vs 5m, p = .00). No OS difference was found between pts who received combination with two or more agents vs single agent CT. Conclusions: In line with multiple studies, analysis of PaCa data from our institution showed an increase OS in pts diagnosed with PaCa in more recent years, and in those who received surgery and CT. CT was administered in a larger number of pts in G2, which might account for the better OS in this group. Pts diagnosed with tumors of the pancreatic head had better survival, which could be explained by earlier presentation leading to earlier diagnosis and tx. Further research in PaCa therapeutics is needed, as long-term OS in PaCa pts remains poor despite recent advances.

Download Full-text