Author/Editor		Repše, Stane
Title		Pankreatoduodenektomija (Whipplova operacija) pri raku trebušne slinavke - lastne izkušnje in 20-letna serija
Translated title		Pancreatoduodenectomy (Whipple's procedure) for the menagement of carcinoma of the pancreas - own experience and 20-year series
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 71, št. 7-8
Publication year		2002
Volume		str. 443-7
Language		slo
Abstract		Background. Pancreatoduodenectomy-the procedure of choice in patients with pancreatic head cancer-has the repuatation as a high risk opartion with frequent postoperative complications, high postoperative mortality and poor 5-year survival. The development of the operative technique in the world and in Slovenia is presented. The autors own 20-year series of patients resected by this method is analysed. Patients and methods. In the period from Jan. 1981 to Dec. 2000 the author resected 58 patients with pancreatic head or periampular cancer. They underwent presumably radical or only paliative procedure (R0, R1, R2)-30 patients with periampullary tumours and 28 patients with ductal adenocarcinoma. In 52 patients classical Whipple pancreatoduodenectomy was performed and in 6 patients pylours preserving pancreatoduodenectomy. In 8 patients it was necessary to enlarge the resection-4 times to partial resection of portal vein, once to total pancreatectomy, once to extended right hemicolectomy and twice to stimultaneous resection of liver methastasis. Results. During postoperative course 6 patients had to be reoperated for surgical complications. Three patients died in the 30 days after operation-postoperative mortality rate 5.2%. Five-year survival rate is known only for the patients who are Slovene residents (38/58). Among them 5 patients lived longer than 5 years (107, 100, 87, 80 and 69 months). At the end of 2001 only 4 resected patients were alive-2 women (3.5 and 3 years after surgery) and 2 men (4 and 3.5 year after surgery). The 5-year survival rate calculated by Kaplan-Meier methods is 22.6%. Conclusions. In spite of numerous postoperative complications and high postoperative mortality pancreatoduodenectomy is the method of choice in pancreatic head cancer patients. It is possible to improve the outcome to lower the postoperative mortality below 5% and to raise the 5-year survival of resected patients over 25%.
Summary		Izhodišča. Cefalična pankreatoduodenektomija metoda izbire pri raku glave trebušne slinavke-je obremenjena s pogostimi pooperativnimi zapleti, z visoko pooperativno smrtnostjo in z nizkim 5-letnim preživetjem. Prikazen je razvoj operacije v svetu in v Sloveniji ter analizirana avtorjeva lastna 20-letna serija reseciranih bolnikov po tej metodi. Bolniki in metode. V obdobju od 1.1.1981 do 31.12.2000 je avtor-domnevno radikalno ali samo paliativno (R0, R1, R2) reseciral 58 bolnikov z rakom glave trebušne slinavke; 30 speriampularnim in 28 z duktalnim karcinomom. Pri 52 bolnikih je naredil klasično cefalično pankreatoduodenektomijo, pri šestih bolnikih pa resekcijo z ohranjenim pilorusom. Pri osmih bolnikih je moral resekcijo razširiti:4-krat z delno resekcijo vene porte, 1-krat v totalno pankreatektomijo, 1-krat z razširjeno desno hemikolektomijo in 2-krat s sočasno resekcijo metastaz v jetrih. Rezultati. V pooperacijskem poteku je bilo potrebno revidirati 6 operirancev. V 30 dneh po operaciji so umrli 3 bolniki-pooperativna smrtnost 5,2%. Petletno preživetje je znano samo za operirance, ki so prebivalci Slovenije (38/58 operirancev). Med temi je več kot 5 let po operaciji preživelo 5 bolnikov (107,100,87,80 in 69 mesecev). Ob koncu leta 2001 so bili živi samo še štirje resecirani bolniki: dve ženski (3, 5 in 3 leta po operaciji) in dva moška (4 in 3,5 leta pooperaciji). Izračunano 5-letno preživetje po Kaplan-Meierjevi metodi je 22,6%. Zaključki. Cefalična pankreatoduodenektomija je kljub številnim pooperacijskim zapletom in visoki pooperacijski smrtnosti metoda izbire pri raku glave trebušne slinavke. Z izkušnjami v kirurgiji trebušne slinavke je mogoče znižati pooperacijsko smrtnost pod 5% in zvišati 5-letno preživetje reseciranih bolnikov nad 25%.
Descriptors		PANCREATICODUODENECTOMY PANCREATIC NEOPLASMS TREATMENT OUTCOME