Indications for Pancreatoduodenal Resection in Treatment of Chronic Pancreatitis Complicated Forms

Abstract

Chronic pancreatitis is a recurrent progressive disease accompanied by fibrosis and fibrocystic degeneration of the pancreatic parenchyma. There are remained the unexplored issues of progression of fibrosis in the pancreas parenchyma, which lead to a rapid enlargement of the head, the development of complications that require a resection surgery. To develop a differentiated approach to the choice of surgical treatments and indications for pancreatoduodenal resection in complicated forms of chronic pancreatitis, a study was performed in 137 patients underwent resection and drainage surgery. Pancreatoduodenal resection was accomplished in 12 patients. Instrumental research methods were used: multidetector (64−slice) computed tomography with 3D reconstruction, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography. Two clinical examples are given. Indications for pancreatoduodenal resection in patients with chronic pancreatitis were expressed fibro−inflammatory process in the area of the pancreas head, suspected development of oncological pathology. Progressive fibrotic changes in the pancreas parenchyma, mainly in the head, occurring in some patients, associated with stellate cell activation and fibrogenesis, they lead to the development of biliary and portal hypertension, stimulation of oncogenesis. It is concluded that with the progression of fibro−inflammatory process in the pancreas head with the development of complications (pancreatic, biliary and portal hypertension), as well as in case of impossibility to exclude the tumor, the surgery of choice is pancreatoduodenal resection. The presence of severe fibrosis in the pancreas parenchyma reduces the risk of developing pancreatic fistula when performing pancreatoduodenal resection. Key words: complicated forms of chronic pancreatitis, pancreatoduodenal resection, fibro−inflammatory process, pancreatic fistula

Tratado de Cirugía General en Atención Primaria en Salud Tomo 21

“…La resección quirúrgica es el tratamiento principal, especialmente para los tumores de bajo riesgo con un índice mitótico bajo [13]. La cirugía cooperativa laparoscópica y endoscópica (LECS, por sus siglas en inglés) es un abordaje mínimamente invasivo que se utiliza para resecar los tumores gastrointestinales, ya que proporciona un diagnóstico preciso y un cuidado postoperatorio óptimo [14]. Con frecuencia, se recomienda la quimioterapia adyuvante con imatinib después de la cirugía para prevenir la recidiva [15].…”

“…En la cirugía torácica, la resección quirúrgica mayor está indicada para prevenir complicaciones catastróficas en pacientes con cáncer avanzado con alto riesgo de invasión vascular [13]. Para la pancreatitis crónica, se recomienda la resección pancreatoduodenal en casos de fibrosis progresiva en la cabeza del páncreas, complicaciones como la hipertensión biliar y portal y sospecha de patología oncológica [14].…”