[Enucleation of pancreatic tumors: a multiple-center study]

OBJECTIVE

To evaluate the immediate results of enucleation of pancreatic neuroendocrine tumors (pNETs).

MATERIAL AND METHODS

The results of enucleation of pancreatic neuroendocrine tumors (pNETs) were analyzed in 95 patients between 2016 and 2021. Functioning tumors (mean size 16.8 mm) were found in 70 patients, non-functioning (mean size 25 mm) - in 25 patients. Intraparenchymal tumors were found in 48 people, extraorganic lesion - in 47 patients.

RESULTS

There were 262 patients with pNETs who underwent various surgeries between 2016 and 2021. Various resections were performed in 167 (63.8%) cases, enucleations - in 95 (36.2%) patients. Traditional surgical approach was used in 65 patients. Pancreatic fistula occurred in 21 patients (type B - 17, type C - 4), while arrosive bleeding occurred in 6 patients with unfavorable outcomes in 2 cases. Minimally invasive surgeries were performed in 30 patients. Eight patients with intraparenchymal tumors required conversion to open surgery. Type B pancreatic fistula occurred in 5 patients that led to arrosive bleeding in 2 cases (hemostasis was provided by endovascular method). Comparison of intraparenchymal and extraorgan tumors regarding the incidence of pancreatic fistula revealed odds ratio 5.26 (95% CI 1.5355; 18.0323, p=0.0041). Postoperative mortality was 2.1%.

CONCLUSION

Enucleation is advisable for highly differentiated pancreatic neuroendocrine tumors up to 2 cm. Minimally invasive enucleation is indicated for extraorgan tumors. Intraparenchymal tumors significantly increase the risk of postoperative complications.

[Pancreaticoduodenectomy - results and prospects (two-center study)]

OBJECTIVE

To summarize the results of pancreaticoduodenectomy (PD) for pancreatic tumors and complications of chronic pancreatitis regarding prediction and prevention of postoperative complications.

MATERIAL AND METHODS

There were 336 PD procedures between 2016 and mid-2022 in two centers. We assessed the factors influencing specific postoperative complications (postoperative pancreatitis, pancreatic fistula, gastric stasis, arrosive bleeding). Several risk factors were distinguished: baseline pancreatic disease and tumor size, CT-signs of a «soft» gland, intraoperative assessment of the pancreas, number of functioning acinar structures. We assessed surgical prevention of pancreatic fistula via preserving adequate blood supply to the pancreatic stump. The last one is provided by extended pancreatic resection and reconstructive stage of surgery, i.e. Roux-en-Y hepatico- and duodenojejunostomy with isolation of pancreaticojejunostomy on the second loop.

RESULTS

Postoperative pancreatitis underlies specific complications after PD. The risk of pancreatic fistula in case of postoperative pancreatitis increases by 5.3 times compared to patients without pancreatitis. Postoperative pancreatic fistula is more common in patients with T1 and T2 tumors. According to univariate analysis, only pancreatic fistula significantly affects the risk of gastric stasis. Among 336 people who underwent PD, pancreatic fistula occurred in 69 patients (20.5%), gastric stasis - in 61 (18.2%), pancreatic fistula complicated by arrosive bleeding - in 45 (13.4%) patients. Mortality rate was 3.6% (n=15).

CONCLUSION

Modern prognostic criteria are valuable to predict specific complications after PD. A promising way to prevent postoperative pancreatitis can be extended pancreatic resection considering angioarchitectonics of the pancreatic stump. Roux-en-Y pancreaticojejunostomy is advisable to reduce aggressiveness of pancreatic fistula.

[Hardware anastomosis in stomach cancer surgery]

AIM

To choose optimal technique of esophagojejunostomy in stomach cancer regarding reliability, functionality and simplicity.

MATERIAL AND METHODS

145 patients with stomach cancer grade I-IV were enrolled. They were divided into 2 groups depending on the type of the anastomosis (manual or hardware).

RESULTS

There were no significant differences between groups in the incidence of anastomosis failure, anastomotic stricture and reflux-esophagitis in long-term postoperative period. At the same time, duration of reconstructive stage with hardware anastomosis was 26±11.3 min, whereas for manual stage - 72±21.9 min (p<0.0001) depending on surgeon's experience.

CONCLUSION

Hardware circular anastomosis in most clinical cases is an alternative to conventional manual anastomosis with the same reliability, safety and functionality. Moreover, principles of hardware anastomosis are the same for open and endoscopic surgery that makes this technique universal and necessary for wide development.