oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2022-21-4-25-31oncotomsk-2236Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESИзолированная резекция вены в хирургическом лечении протоковой карциномы поджелудочной железы как фактор резектабельностиSingle vein resection in surgery for pancreatic ductal carcinoma as a criterion of resectabilityЧичеватовД. А.ChichevatovD. A.

Чичеватов Дмитрий Андреевич - доктор медицинских наук, профессор кафедры хирургии.

440026, Пенза, ул. Красная, 40.

Researcher ID: Q-3647-2017.

Dmitry A. Chichevatov - MD, Professor, Department of Surgery, Penza State University.

40, Krasnaya St., 440026, Penza.

Researcher ID (WOS): Q-3647-2017.

chichevatov69@mail.ruКалентьевВ. В.KalentjevV. V.

Калентьев Вячеслав Викторович - врач хирургического отделения № 2.

440066, Пенза, пр. Строителей, 37А.

SPIN-код: 3235-6383.

Vyacheslav V. Kalentjev - MD, Surgeon, Department of Surgery, Penza Regional Oncology Hospital.

37 A, Prospect Stroiteley, 440066, Penza.

ГлуховА. Е.GlukhovA. E.

Глухов Артем Евгеньевич - ассистент кафедры хирургии.

440026, Пенза, ул. Красная, 40.

SPIN-код: 9136-7827.

Artem E. Glukhov - MD, Department of Surgery, Penza State University.

40, Krasnaya St., 440026, Penza.

Пензенский государственный университетРоссияPenza State UniversityRussian FederationОбластной онкологический диспансерРоссияPenza Regional Oncology HospitalRussian Federation2022020920222142531Copyright © Чичеватов Д.А., Калентьев В.В., Глухов А.Е., 20222022Чичеватов Д.А., Калентьев В.В., Глухов А.Е.Chichevatov D.A., Kalentjev V.V., Glukhov A.E.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/2236

Лечение протоковой карциномы поджелудочной железы (ПКПЖ) с вовлечением верхней брыжеечной и/или воротной вены остается предметом дискуссий. Мы оценили венозную инвазию как критерий пограничной резектабельности и отдаленного прогноза заболевания. Материал и методы. В нашем центре 68 пациентов оперированы в объеме стандартной панкреатодуоденальной резекции (n=65) или панкреатодуоденэктомии (n=3) по поводу ПКПЖ. В 18 (26,5 %) наблюдениях выполнена резекция верхней брыжеечной и/или воротной вены. Неоадъювантную химиотерапию (НАХТ) получили 3 пациента, адъювантная химиотерапия (АХТ) начата у 37 (54,4 %) пациентов. Результаты. Частота послеоперационных осложнений в группе стандартных операций и ангиопластических операций (42,0 против 50,0 %, р=0,590), частота летальных исходов (4 против 16,7 %, р=0,111) значимо не отличались. АХТ закончена полностью у 10 (16,7 %) пациентов. Истинная инвазия опухоли отмечена у 12 из 18 пациентов с резекцией вены. Независимыми предикторами общей выживаемости (ОВ) были рN+ (р=0,012) и наличие ангиопластики (р=0,000). У пациентов с резекцией вены медиана ОВ составила 9,4 мес. В группе стандартных ПДР медиана ОВ была 26,9 мес (р=0,000). У пациентов с резекцией вены медиана ОВ при законченной химиотерапии составила 17,7 мес, без химиотерапии – 8,9 мес (р=0,439). Заключение. ПДР с резекцией вены и отсутствием или незавершенной химиотерапией может рассматриваться как неоправданная операция. Данную операцию целесообразно выполнять после эффективной НАХТ.

Background. Pancreatic ductal carcinoma (PDC) with involvement of the superior mesenteric vein (SMV) or/ and portal vein (PV) remains a discussible subject. We have evaluated vein invasion as a criterion of borderline resectability and long-term outcome. Material and methods. In our center, 68 patients underwent either 65 standard pancreatoduodenal resections or 3 pancreatoduodenectomies for PDC. Resection of SMV/PV was performed in 18 cases (26.5 %). Three patients received neoadjuvant chemotherapy (NACT), and adjuvant chemotherapy (ACT) was assigned to 37 patients (54.4 %). Results. Morbidity (42.0 vs 50.0 %, р=0.590) and mortality rates (4.0 vs 16.7 %, р=0.111) had no significant differences in groups of standard and angioplasty operations respectively. ACT was completed in 10 (16.7 %) patients only. There was true vein invasion in 12 of 18 patients with vein resection. рN+ (р=0.012) and angioplasty by itself (р<0.001) were found out as independent predictors of overall survival (OS). the median OS was 9.4 mo in patients with vein resection. in the group of standard operations, the median OS was 26.9 mo (р<0.001). The median OS in patients with vein resection and complete chemotherapy was 17.7 mo in contrast to 8.9 mo in those who did not receive chemotherapy (р=0.439). Conclusions. PDR with vein resection and incomplete chemotherapy cannot be regarded as a reasonable procedure. PDR with vein resection may be appropriate after efficient NACT.

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The authors declare that there are no conflicts of interest present.