Developments in pancreatic surgery at the 1^st Surgical Department 1^st Faculty of Medicine, Charles University and General University Hospital in Prague

Česká verzia

Authors: Z. Krška; J. Šváb
Authors place of work: I. chirurgická klinika 1. LF UK a VFN, Praha, přednosta: Prof. MUDr. Zdeněk Krška, CSc.
Published in the journal: Rozhl. Chir., 2012, roč. 91, č. 5, s. 262-266.
Category: Original articles

Summary

Introduction:
Surgical treatment of pancreatic diseases has been going through certain changes and developments. This article aims to describe the changes in diagnosis and treatment that have occurred over the years.

Material and methods:
Groups of patients from three different periods (1954–1999, 2002–2006 and 2007–2011), all of them having undergone elective follow-up for the diagnosis of acute or chronic pancreatitis (AP, CHP), pancreas and papilla tumours, terminal choledochus, and other less common tumours in this region, are described. Monitoring has focused on the indication criteria, the extent and method of the surgical procedure, perioperative lethality and morbidity, including complications, and also survival rate.

Results:
In AP patients we recorded a significant drop in indications to surgery (38% vs. 16%), a shift in intervention time from 8.9 to 22.5 days, a decrease in lethality by 24%, or, as the case may be, by 3.5% (yet 7.9% during the first three months). The results show the domination of open abdominal procedures and a rising number of non-interventions. In CHP patients we detected a 30% increase in the number of resection procedures /Whipple/, a slight increase in drainage procedures (by 6%), and a decrease in drainage-resection procedures. The overall drop in the number of procedures in CHP patients probably relates to endoscopic and miniinvasive treatment. In pancreatic tumours we found domination of adenocarcinoma (92.6%), but also an increase in the number of cystic and endocrine tumours (2.6% and 4.8%) as a result of diagnostics and centralisation of care. We also recorded a decrease in exploratory laparotomy cases to 12%. In patients with resectable tumours we performed hemipancreatoduodenectomy in 90%, posterior approach in 2%, and vascular resection in only 4%. Perioperative lethality stagnates around 2.8%. Median survival rate has remained unchanged, as has long-term survival rate.

Conclusion:
Although treatment in general has not recorded any revolutionary and fundamental benefits, its surgical modality still represents the principal treatment and can be considered curative, even in tumours. Pancreatic diseases remain to be seen as a multidisciplinary issue and must be approached and dealt with as such, optimally in large-volume centres.

Key words:
acute pancreatitis – chronic pancreatitis – pancreatic adenocarcinoma – cystic tumours – endocrine tumours

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