| Autor: |
Egorov V; Surgical Oncology Department, Ilyinskaya Hospital, 143421 Moscow, Russia., Kim P; HPB Department, Ilyinskaya Hospital, 143421 Moscow, Russia., Kharazov A; Vascular Surgery Department, Vishnevsky National Medical Research Center of Surgery, 117997 Moscow, Russia., Dzigasov S; Vascular Surgery Department, Ilyinskaya Hospital, 143421 Moscow, Russia., Popov P; Radiology Department, Ilyinskaya Hospital, 143421 Moscow, Russia., Rykova S; Radiology Department, Ilyinskaya Hospital, 143421 Moscow, Russia., Zelter P; Radiology Department, Samara State Medical University, 443099 Samara, Russia., Demidova A; Radiology Department, Ilyinskaya Hospital, 143421 Moscow, Russia.; Department of Ultrasound Diagnostics, Pirogov Russian National Research Medical University, 117997 Moscow, Russia., Kondratiev E; Radiology Department, Ilyinskaya Hospital, 143421 Moscow, Russia., Grigorievsky M; Department of Hospital Surgery, Evdokimov Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia., Sorokin A; Mathematical Statistics and Econometrics Department, Plekhanov Russian University of Economics, 117997 Moscow, Russia. |
| Abstrakt: |
DPCAR’s short- and long-term outcomes are highly diverse, while the causes and prevention of ischemic complications are unclear. To assess oncological, surgical, and hemodynamic outcomes of 40 consecutive DPCARs for pancreatic (n37) and gastric tumors (n3) (2009−2021), retrospective analyses of mortality, morbidity, survival, and hemodynamic consequences after DPCAR were undertaken using case history data, IOUS, and pre- and postoperative CT measurements. In postoperative complications (42.5%), the pancreatic fistula was the most frequent event (27%), 90-day mortality was 7.5. With 27 months median follow-up, median overall (OS) and progression-free survival (PFS) for PDAC were 29 and 18 months, respectively; with 1-, 3-, and 5-years, the OS were 90, 60, and 28%, with an R0-resection rate of 92.5%. Liver and gastric ischemia developed in 0 and 5 (12.5%) cases. Comparison of clinical and vascular geometry data revealed fast adaptation of collateral circulation, insignificant changes in proper hepatic artery diameter, and high risk of ischemic gastropathy if the preoperative diameter of pancreaticoduodenal artery was <2 mm. DP CAR can be performed with acceptable morbidity and survival. OS and RFS in this super-selective cohort were compared to those for resectable cancer. The changes in the postoperative arterial geometry could explain the causes of ischemic complications and determine directions for their prevention. |
