Pancreatic cancer surgery — experience of one medical center

BACKGROUND: This article offers detailed information about the surgical treatment of pancreatic cancer, based on the experience of the abdominal department of Samara Regional Clinical Oncological Dispensary (Samara, Russian Federation). This allows readers to familiarize themselves with the achievements and innovations in this field, to get information about constantly improving surgical methods and their effectiveness. Such information can help not only patients, but also medical professionals, including surgeons, to improve the quality and effectiveness of operations. The article also includes an overview of the main methods of diagnosing pancreatic cancer, which can help specialists identify the disease at an early stage and improve their working methods. It provides up-to-date information on the diagnosis, treatment and prognosis of pancreatic cancer, which can help improve treatment outcomes and prolong the survival of patients suffering from this disease.

AIM: Analysis of the state of oncological care for patients with pancreatic cancer in the Samara region over the past 5 years.

METHODS: The results of treatment of 236 patients with pancreatic cancer operated in the department of abdominal oncology of the Samara Regional Clinical Oncology Dispensary in the period from 2018 were studied.

RESULTS: According to the results of treatment, pancreatic cancer stage IA was established in 9.74% of patients (n=23), stage IV — in 5.89% (n=14), stage IIA — 12.71% (n=30), stage IIB — in 12.71% (n=30); stage III — in 23.30% (n=55), stage IV — in 35.59% (n=84) of patients. Of the 76 patients with initially unresectable tumors, 12 received neoadjuvant chemotherapy according to the FOLFIRINOX scheme, which allowed them to perform radical surgery. The average age of the patients was 62.2 years. The overall survival rate in the entire group of patients was 20 months. It is interesting to note that in the group of patients with stage III, the 1-year survival rate was 20.53%, which is lower than in the group of patients with stage IV (25.59%). Most likely, this is due to postoperative complications and mortality in patients with stage III who underwent radical treatment (while patients with stage IV underwent gentle palliative surgery).

CONCLUSIONS: Pancreatic cancer is a complex disease that requires an interdisciplinary approach to achieve the necessary diagnosis and develop optimal treatment tactics. Radical surgery is disabling, but remains the only treatment option for pancreatic cancer, which determines the patient’s life prognosis. The results of gastropancreatoduodenal resection are characterized by a significant frequency of postoperative complications (34.38%), with a high rate of postoperative mortality (20.93%). Unsatisfactory results of surgical treatment of pancreatic cancer indicate the need to develop more effective methods of complex treatment. The lack of verification of pancreatic cancer at the prehospital stage in the majority of patients (84.6%) does not allow chemotherapy treatment in the neoadjuvant mode for locally advanced forms, which dooms patients to diagnostic surgery. As a result, valuable time is lost, which calls into question the well-being of such patients. The development of new, more effective diagnostic methods at the outpatient stage will solve this problem.