[Pancreatic cancer surgery at Ist Surgical Clinic of the Olomouc Faculty Hospital (FN Olomouc)]

Abstract

Introduction: Surgical treatment plays a key role in the efforts to improve prognosis of patients with pancreatic cancer. The pancreatic cancer incidence rates are on increase and so does the number of patients undergoing potentially curative resection procedures. However, despite all diagnostic advancements and treatments adjusted to specific patient's needs, the outcomes are not satisfactory enough. The aim of the surgical procedure is to radically remove the tumor, including the regional lymph nodes, to promote early and uncomplicated healing and to facilitate early initiation of oncological treatment.

Aim: The aim of the study was to assess current potential of diagnostic and surgical treatment in pancreatic cancer when all currently available diagnostic methods are emloyed and to present the university clinic's outcomes. METHODS AND PATIENT GROUP: From 2006 to IX 2010, a total of 177 pancreatic resections and 123 right-sided pancreatoduodenectomies for malignant disorders were performed at the authors' clinic. 76 pancreatoduodenectomies were performed for ductal carcinoma of the pancreatic head. The study group included 51 males and 25 females, the mean age of 62.9 years. Based on the TNM classification (UICC), 11% of the subjects presented with stage I, 78% with stage II and 3% with stage III diseases. The procedures radicality was the following: R0 in 59 subjects, R1 in 5 subjects while in 12 subjects, the radicality was undetected by the authors. Histopatological grading in this patient group was as follows: G1 in 20%, G2 in 34% and G3 in 46% of the subjects. Perineural invasion, invasion into lymphatic vessels or other vessels was not detected in 21 subjects (27.6%). The authors assessed complication rates based on the DeOliveira classification and survival rates in individual disease stages.

Outcomes: Complications occurred in 44.7% of the operated subjects. Serious complications requiring reintervention were reported in 13 subjects (17.1%), including reinterventions in general anesthesia in 10 subjects (13.1%). Two patients died: a 79-year old female died from multiorgan failure as a result of aspiration, and a 76-year old male died from multiorgan failure following completion of pancreatectomy due to pancreaticojejunal anastomosis insufficiency. The thirty- and sixty-day mortality rate was 2.6%, however, it was null over the past three years. The mean survival time was 17.1 months, with the median of 13.5 months. The patient group's overall 3-, 6-, 9-, 12, 15- and 18- month survival following radical resections was 95.6%, 90.3%, 76.3%, 62.7%, 52.3% and 45%, respectively. 82%, 52%, 35% and 35% of the operated stage I patients survived 1, 2, 3 and 4 years, respectively. The mean hospitalization duration was 16.8 days (10-45).

Conclusion: Although the procedures are extremely demanding, especially in the reconstruction phase, the outcomes have improved significantly due to ongoing experience, improvements in the surgical technique and in the complex postoperative care. At specialized clinics, the mortality rate has dropped below 5%, the morbidity rate below 40% and the postoperative dehiscence rates below 10%. During the past three years, the authors' clinic has reached null 30- and 60-day mortality rate following the pancreatic head resections, the complication rate following pancreaticoduodenal anastomosis is slightly above 5% (6.5%) and the morbidity rate is slightly above 40% (44.7%). The authors consider the procedure safe at their clinic and all indicated patients are expected to benefit from it.