Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis

Sled N.Yu.; Sled O.N.; Merzlikin N.V.; Tskhai V.F.; Narkevich A.N.; Bushlanov P.S.

doi:https://doi.org/10.17116/hirurgia2021081116

Sled N.Yu.

Regional state budget institution of Health «Krasnoyarsk inter-regional clinical hospital N20 named for I.S. Berzona»

Sled O.N.

Regional state budget institution of Health «Krasnoyarsk inter-regional clinical hospital N20 named for I.S. Berzona»

Merzlikin N.V.

Siberian State Medical University of the Ministry of Health of the Russian Federation

Tskhai V.F.

Siberian State Medical University of the Ministry of Health of the Russian Federation

Narkevich A.N.

Voyno-Yasenetsky State Medical University

ORCID: 0000-0002-1489-5058

Bushlanov P.S.

Siberian State Medical University of the Ministry of Health of the Russian Federation

Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis

Authors:

Sled N.Yu., Sled O.N., Merzlikin N.V., Tskhai V.F., Narkevich A.N., Bushlanov P.S.

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Journal: Pirogov Russian Journal of Surgery. 2021;(8): 116‑124

DOI: 10.17116/hirurgia2021081116

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To cite this article:

Sled NYu, Sled ON, Merzlikin NV, Tskhai VF, Narkevich AN, Bushlanov PS. Analysis of the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of treatment of chronic pancreatitis. Pirogov Russian Journal of Surgery. 2021;(8):116‑124. (In Russ.)
https://doi.org/10.17116/hirurgia2021081116

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

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AIM

Compare the short and long-term results of traditional duodenum-saving resections of the pancreas head and the original resection-draining method of the surgery of chronic pancreatitis

MATERIALS AND METHODS

There has been the analysis of the immediate and long-term results of various types of duodenum-saving operations in 48 patients with chronic pancreatitis since 2011 to 2020. The patients were divided into two groups: the control group (n=26) where typical duodenum-saving operations were performed, and the study group (n=22) — the original resection-draining method of surgery.

RESULTS

The groups had no difference in gender, age, clinical manifestations. After typical duodenum-saving operations, the number of postoperative complications was higher than after original resection-draining method (31 [14; 52]% and 23 [8; 45]% respectively). In the control group the incidence of pancreatic fistula 19% [7; 39], hemorrhagic complications 12% [2; 30] was higher. In both groups, one patient died in the early postoperative period. However, these differences were statistically insignificant. 12 (52% [31; 73]; p<0.001) patients have died in the control group for the 9-year observation period, mainly (7 cases) as a result of the progression of chronic pancreatitis against the background of alcoholism. The groups had no difference in the level of pain reduction, development of dyspeptic syndrome and diabetes mellitus.

CONCLUSIONS

The proposed original technique of subtotal resection of the head, ventral part of the body and tail of the pancreas with longitudinal pancreatojejunoanastomosis made it possible to improve the short-term results and reduce the incidence of pancreatic fistula formation. Taking into account the level of compliance the selection of patients permitted to achieve a better quality of life according to the results of the SF — 36 questionnaire and to reduce the lethality to 5 [0; 25]% (p<0.001) in the long-term period. Statistically significant difference was obtained for three of the five criteria, the total value of the physical (PCS, p=0.033) and mental (MCS, p=0.032) health components.

Keywords:

chronic pancreatitis

duodenum-saving operations

resection-draining methods of surgery

surgical treatment

Authors:

Sled N.Yu.

Regional state budget institution of Health «Krasnoyarsk inter-regional clinical hospital N20 named for I.S. Berzona»

Sled O.N.

Regional state budget institution of Health «Krasnoyarsk inter-regional clinical hospital N20 named for I.S. Berzona»

Merzlikin N.V.

Siberian State Medical University of the Ministry of Health of the Russian Federation

Tskhai V.F.

Siberian State Medical University of the Ministry of Health of the Russian Federation

Narkevich A.N.

Voyno-Yasenetsky State Medical University

ORCID: 0000-0002-1489-5058

Bushlanov P.S.

Siberian State Medical University of the Ministry of Health of the Russian Federation

Received:

08.06.2021

Accepted:

10.07.2021

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References:

Singh VK, Yadav D, Garg PK. Diagnosis and Management of Chronic Pancreatitis: A Review. JAMA. 2019;22(24):2422-2434. https://doi.org/10.1001/jama.2019.19411
Gal’perin EI. Klassifikaciya hronicheskogo pankreatita: opredelenie tyazhesti, vybor metoda lecheniya i neobhodimoj operacii. Annaly hirurgicheskoj gepatologii. 2014;18(3):83-93. (In Russ.).
Dua MM, Visser BC. Surgical Approaches to Chronic Pancreatitis: Indications and Techniques. Dig Dis Sci. 2017;62(7):1738-1744. https://doi.org/10.1007/s10620-017-4526-x
Kempeneers MA, Issa Y, Ali UA, Baron RD, Besselink MG, Büchler M, Erkan M, Fernandez-Del Castillo C, Isaji S, Izbicki J, Kleeff J, Laukkarinen J, Sheel ARG, Shimosegawa T, Whitcomb DC, Windsor J, Miao Y, Neoptolemos J, Boermeester MA. Working group for the International (IAP-APA-JPS-EPC) Consensus Guidelines for Chronic Pancreatitis. International consensus guidelines for surgery and the timing of intervention in chronic pancreatitis. Pancreatology. 2020;20(2):149-157. https://doi.org/10.1016/j.pan.2019.12.005
Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis. Ann Surg. 2010;251(1):18-32. https://doi.org/10.1097/SLA.0b013e3181ae3471
Liu L, Zhu Y, Noë M, Li Q, Pasricha PJ. Neuronal Transforming Growth Factor beta Signaling via SMAD3 Contributes to Pain in Animal Models of Chronic Pancreatitis. Gastroenterology. 2018;154(8):2252-2265.e2. https://doi.org/10.1053/j.gastro.2018.02.030
Kemper M, Izbicki JR, Bachmann K. Surgical Treatment of Chronic Pancreatitis: The State of the Art. Chirurgia (Bucur). 2018;113(3):300-306. https://doi.org/10.216114/chirurgia.113.3.300
Merzlikin NV, Brazhnikova NA, Ckhaj VF, Klinovickij IYu, Komkova TB, Sotnikov AA, Yaroshkina TN, Shtofin SG, Sled NYu. Pankreatit. M.: GEOTAR-Media; 2014. (In Russ.).
Zhou Y, Shi B, Wu L, Wu X, Li Y. Frey procedure for chronic pancreatitis: Evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: A meta-analysis. Pancreatology. 2015;15(4):372-379. https://doi.org/10.1016/j.pan.2015.05.466
Jawad ZAR, Tsim N, Pai M, Bansi D, Westaby D, Vlavianos P, Jiao LR. Short and long-term postoperative outcomes of duodenum preserving pancreatic head resection for chronic pancreatitis affecting the head of pancreas: a systematic review and meta-analysis. HPB (Oxford). 2016;18(2):121-128. https://doi.org/10.1017/j.hpb.2015.10.003
Zhao X, Cui N, Wang X, Cui Y. Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimoro). 2017;96(9):e6220. https://doi.org/10.1097/MD.0000000000006220
Kozlov IA, Vishnevskij VA, Chzhao AV, Bajdarova M.D. Vybor sposoba hirurgicheskogo lecheniya hronicheskogo pankreatita. Prakticheskaya medicina. 2017;6:32-40. (In Russ.).
Fischer TD, Gutman DS, Warner EA, Trevino JG, Hughes SJ, Behrns KE. Local pancreatic head resection: the search for optimal indications through quality of life assessments. Am J Surg. 2015;210(3):417-423. https://doi.org/j.amjsueg.2014.12.049
Zaharova MA, Kriger AG, Karmazanovskij GG, Kondrat’eva EV, Gal’china YuS. Otdalennye rezul’taty rezekcii golovki podzheludochnoj zhelezy pri hronicheskom pankreatite. Hirurgiya. Zhurnal im. N.I. Pirogova. 2021;1:47-54. (In Russ.). https://doi.org/10.17116/hirurgia202101147
Tustumi F, Costa TN, Penteado S, Bacchella T, Cecconello I. Long Term Follow-up Results of Surgical Management of Chronic Pancreatitis. Chirurgia (Bucur). 2019;114(3):369-375. https://doi.org/10.21614/chirurgia.114.3.369
Tillou JD, Tatum JA, Jolissaint JS, Strand DS, Wang AY, Zaydfudim V, Adams RB, Brayman KL. Operative management of chronic pancreatitis: A review. Am J Surg. 2017;214(2):347-357. https://doi.org/10.1016/j.amjsurg.2017.03.004
Sled NYu, Cherdancev DV, Popov AE, Merzlikin NV, Pozdnyakov AA, Sled ON. Otdalennye rezul’taty hirurgicheskogo lecheniya hronicheskogo kistoznogo pankreatita. Sibirskoe medicinskoe obozrenie. 2015;94(4):42-47. (In Russ.). https://doi.org/10.20333/25000136-2015-4-42-46
Bellon E, Roswora MD, Melling N, Grotelueschen R, Grupp K, Reeh M, Ghadban T, Izbicki JR, Bachmann K. Duodenum-preserving pancreatic head resection: A retrospective analysis of the Hamburg Modification. Surgery. 2019;165(5):938-945. https://doi.org/10.1016/j.surg.2018.11.009
Kozlov IA, Bajdarova MD, Shevchenko TV, Ikramov RZ, Zharikov YuO. Proksimal’nye rezekcii podzheludochnoj zhelezy. Blizhajshie rezul’taty. Annaly hirurgicheskoj gepatologii. 2020;25(4):107-117. (In Russ.). https://doi.org/10.16931/1995-5464.20204107-117
Pronin NA, Natal’skij AA, Tarasenko SV, Pavlov AV, Fedoseev VA. Optimizaciya tekhniki operacij u bol’nyh hronicheskim pankreatitom. Hirurgiya. Zhurnal im. N.I. Pirogova. 2017;12:41-45. (In Russ.). https://doi.ord/10.17116/hirurgia20171241-45
Kabanov MYu, Solov’ev IA, Yakovleva DM, Semencov KV, Kradenov AV. Oktreodit-depo v profilaktiki i lechenii naruzhnyh pankreaticheskih svishchej. Vestnik Nacional’nogo mediko-hirurgicheskogo Centra im. N.I. Pirogova. 2013;8(1):26-28. (In Russ.).
Alghamdi AA, Jawas AM, Hart RS. Use of octreotide for the prevention of pancreatic fistula after elective pancreatic surgery: a systematic review and meta-analysis. Can J Surg. 2007;50(6):459-466.