Vol 27, No 6 (2022)

BACKGROUND: Surgery is the only treatment option for tumors of the head and tail. To date, the most optimal operations used for tumors of the head of the pancreas are gastro-pancreatoduodenal resection, and for tumors of the tail — distal subtotal resection of the pancreas and splenectomy. The main access for these operations is median laparotomy. In our article, we analyze the surgical interventions that have been performed for pancreatic cancer in our center, Samara Regional Clinical Oncological Dispensary.

AIM: Analysis of surgical interventions for pancreatic cancer in the Samara Regional Clinical Oncological Dispensary to assess the immediate and long-term results of surgical treatment.

METHODS: This article presents the results of treatment of 236 patients with pancreatic cancer in the Department of abdominal Oncology of the Samara Regional Clinical Oncology Dispensary from 2018 to 2023. Most patients underwent surgical interventions, including choledochal stenting, bile duct drainage, and cholecystostomy. In inoperable or unresectable processes, palliative surgery was performed, such as the formation of cholecystoenteroanastomosis and gastroenteroanastomosis. Most of the patients underwent radical surgery, and some of them were preceded by neoadjuvant polychemotherapy. In the postoperative period, various reconstruction methods were performed, including the formation of pancreato-gastro-anastomosis and pancreatoejunoanastomosis. Combined operations were also performed in some patients with tumor invasion of adjacent organs.

RESULTS: The medical records of 99 patients who underwent radical surgery were examined. 30 of them had significant clinical complications according to the Clavien–Dindo classification and included pancreatic fistula, failure of pancreatoejunoanastomosis, failure of pancreato-gastro-anastomosis and subhepatic abscess. All patients underwent laparotomy, sanitation and drainage of the abdominal cavity, and continued treatment in intensive care units. Some patients required a relaparotomy to stop intra-abdominal erosive bleeding. The mortality rate was 12.02%, the cause of death in some cases was the failure of pancreatoenteroanastomosis together with pancreatic fistula and cardiopulmonary insufficiency caused by pulmonary embolism. The patients were divided into four groups depending on the operation performed. Mortality after distal subtotal pancreatic resection was 2.02%, after.

CONCLUSION: Surgical intervention is the main method of treating pancreatic cancer. Radical surgery is a key factor that affects the prognosis of the disease. However, the lack of verification of pancreatic cancer before admission to the hospital does not allow chemotherapy to be performed in the mode of preoperative treatment for a common form of the disease. In about 70% of patients, the syndrome of mechanical jaundice becomes the first manifestation of the disease, which requires additional methods of diagnosis and treatment. The complexity of the operation lies in the proximity of the pancreas to vascular structures. Most patients are already inoperable at the time of diagnosis confirmation due to the spread of the tumor process. Due to the technical complexity of operations, the high number of complications and high postoperative mortality, treatment of pancreatic cancer should be carried out in large specialized centers. The treatment of the disease requires interdisciplinary cooperation to achieve optimal diagnosis.

Adenoid cystic cancer of the salivary glands is characterized by recurrent and/or metastatic course. Compared with other histological types of salivary gland cancer, it usually has a more latent clinical course with a low incidence of spread to regional lymph nodes. However, after removal of the primary tumor, local and distant relapses are quite common. In addition, the presence of prognostic factors such as metastases in the lymph nodes of the neck, low degree of tumor differentiation, perineural and lymphovascular invasion contributes to an increase in the frequency of distant metastasis with a poor prognosis.

Cases of atypical arrangement of salivary gland tissues with extranodal heterotopia are rare. In the head and neck region, different localizations of heterotopia of salivary gland tissues have been described, but the pterygopalatine fossa was not mentioned in the available sources. The difficulty of histological diagnosis when verifying heterotopia of the salivary glands may be due to the phenomena of chronic inflammation, lymphoid infiltration, tissue fibromatosis and the development of metaplasia. The rare occurrence of heterotopia of the salivary glands, the difficulties of its diagnosis and the lack of a unified approach to surgical treatment require consideration of each individually identified case.

The law of paired cases (also known as the law of series) is implemented in the interpretation of the presented clinical cases, when the identification of individual extraorgan foci of adenoid cystic cancer of the pterygopalatine space may be associated with a rare extranodal heterotopia of salivary gland tissue. The primary multiplicity of malignant lesions of the major salivary glands and heterotopia of salivary gland tissue can be both synchronous and metachronous. Adenoid cystic cancer of the pterygomaxillary fossa, as a component of multicentric growth of various localizations, clinically confirmed the recurrent nature of the course, the tendency to distant metastasis and generalization of the malignant process.