The application of pancreaticoejunoanastomosis drainage after gastropancreatoduodenal resection for malignant formations of the pancreas and large duodenal papilla

   Introduction. Currently, the success of the treatment of neoplasms of the pancreatoduodenal zone is largely due to the surgical stage. The incidence of pancreatodigestive anastomosis failure after performing gastropancreatoduodenal resection (GPDR) ranges from 1% to 58%.
   The purpose of the study. To improve the results of surgical treatment of patients after GPDR by using long-term skeletal drainage of pancreatoejunonastomosis.
   Materials and methods. The experience of the general surgery clinic is 32 gastropancreatoduodenal resections. In 29 cases, the operation was performed for malignant tumors of the head of the pancreas, which amounted to 90,6 %. For cancer of the large duodenal papilla, 3 surgical interventions were performed. According to the TNM classification (2010), stage I and II of a malignant tumor were detected in 75 %, and stage III was diagnosed in 25 % of cases. Decompression of pancreatic and biliodigestive anastomoses was performed using long-term skeletal drainage of the main pancreatic duct by Felker in 27 patients (84,4 %). In five cases, an ivagination PA was applied (15,6 %).
   Treatment results. In 6 (23,6 %) patients who underwent GPDR with long-term skeleton drainage, the failure of PEA was diagnosed early, with the formation of pancreatic fistula type "B". Of the 5 patients who did not undergo skeleton drainage, 3 patients had uncomplicated postoperative period. In two (40 %) observations, "C" type fistulas developed.
   Conclusion. Improvement of postoperative GPDR results can be achieved through the use of long-term frame drains.

1. Kubyshkin V. A., Vishnevsky V. A. Pancreatic cancer. M.: Medpraktika, 2013. 385 p. (In Russ.)

2. Levenick J., Sutton J., Smith K., Gordon S., Suriawinata A., Gardner T. Pancreaticoduodenectomy for the treatment of groove pancreatitis. Dig. Dis. Sci. Jul., 2012, № 57 (7), рр. 1954–1958. doi: 10.1007/s10620-012-2214-4

3. Daamen L., Smits F., Besselink M., Busch O., Borel Rinkes I., van Santvoort H., Molenaar I. A web-based overview, systematic review and meta-analysis of pancreatic anastomosis techniques following pancreato-duodenectomy. HPB (Oxford), 2018, № 20 (9), рр. 777–785. doi: 10.1016/j.hpb.2018.03.003

4. Bassi C., Marchegiani G., Dervenis C. et. al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery, 2017, № 161(3), рр. 584–591. doi: 10.1016/j.surg.2016.11.014

5. Figueras J., Sabater L., Planellas P., Muñoz-Forner E., Lopez-Ben S., Falgueras L., Sala-Palau C., Albiol M., Ortega-Serrano J., Castro-Gutierrez E. Randomized clinical trial of pancreaticogastrostomy versus pancreatico-jejunostomy on the rate and severity of pancreatic fistula after pancreaticoduodenectomy. Br. J. Surg., 2013, № 100 (12), рр. 1597–1605. doi: 10.1002/bjs.9252

6. Kushiya H., Nakamura T., Asano T. et al. Predicting the Outcomes of Postoperative Pancreatic Fistula After Pancreatoduodenectomy Using Prophylactic Drain Contrast Imaging J. Gastrointest Surg., 2020, № 25 (6), рр. 1445–1450. doi: 10.1007/s11605-020-04646-y

7. Topal B., van de Sande S., Fieuws S. et al. Effect of centralization of pancreaticoduodenectomy on nationwide hospital mortality and length of stay. Br. J. Surg., 2007, № 94 (11), рр. 1377–1381. doi: 10.1002/bjs.5861

8. Ivanusa S. Ya., Lazutkin M. V., Alentyev S. A. Modern possibilities of using X-ray endovascular interventions in the diagnosis and treatment of inflammatory diseases of the pancreas. Military Medical Journal, 2014, № 335 (9), pp. 36–42. (In Russ.) URL: https://journals.eco-vector.com/0026-9050/article/view/74281/ru_RU