| Popis: |
During 1998-2000 (till October 1) 55 radical operations on the pancreas because of periampullary carcinoma were performed in Kaunas Medical University Hospital. There were 50 pancreatoduodenal resections (PDR) and 5 total pancreatectomies (PE). Age of patients ranged from 28 to 78 years, mean age was 61.9 years. Thirty six percent (36.4%) of patients were older than 70 years. Carcinoma of the head of the pancreas was diagnosed in 48 (87.3%) cases, common bile duct carcinoma in 3 (5.5%) cases, carcinoma of p. Vateri in 2 (3.6%) cases and carcinoma of duodenum in 2 (3.6%) cases. Twenty five (45.5%) patients were suffering from first or second stage cancer, 28 (50.9%)--from third stage. Stage IV was diagnosed for 2 (3.6%) patients, due to invasion to the portal, mesenteric or splenic veins. For those patients resection of portal, mesenteric or splenic veins was performed. Malignant invasion to the resection margin of the pancreas was found in 4 (7.3%) patients. Regional lymphadenectomies (D1) were performed in 23 cases and radical lymphadenectomies (D2) in 32 cases. There was no statistically significant difference in overall morbidity after the operations between those two groups. Hospital mortality in PDR group was 8% (4 pts.) and 20% (1pt.) in PE group. Actuarial survival was estimated based on data of February 1, 2001. Survival function was compared between patients who underwent radical (n = 50) and palliative (n = 43) operations. Median survival time after radical operations was 382 days, whereas after palliative operations--128 days. As postoperative morbidity is not influenced by the extent of lymphadenectomy, D2 dissection should be performed. The pancreatic resection during PDR should be performed through macroscopically normal pancreatic tissue. PE is recommended if the macroscopical invasion to distal part of the pancreas is present. |
