Cryoablation technologies in complex treatment of patients with malignant pancreatic tumor
The number of patients with pancreatic malignant tumors increases every year worldwide. The only radical method of treatment is surgical one. It can only be used in 15-20% of cases. The median of survival in patients with unresectable pancreatic cancer varies from 3 to 6 months. The 5-year survival is 0%.Materials and methods. The use of cryoablation (CA) was studied both in patients with unresectable and resectable pancreatic cancer. The patients were retrospectively divided into 2 groups. In the group A, the CA of the residual pancreatic tumor was conducted, if it was impossible to achieve the R0-resection. Twenty two patients after CA of residual tumor on main vessels were assigned to the subgroup A1. Twelve patients with the residual tumor along the edge of the pancreas transection were assigned to the subgroup A2. Comparative analysis of the results of treatment of these subgroups was conducted with the control group AC, where 10 patients with R2-resection after palliative PDR were assigned.Unresectable patients were included in the group B. They underwent the CA of tumor (hereinafter cryocytoreduction) as a step in the shunting operation. Fourteen patients were assigned to the subgroup B1, where the cryocytoreduction of tumor was conducted without transection of the pancreas. Nine patients were assigned to the subgroup B2, where the cryocytoreduction of tumor was conducted after the transection of the pancreas. Comparative analysis of the results of treatment of these subgroups was carried out with the control group BC, in which 25 patients underwent the standard shunting operations (formation of biliodigestive anastomosis with or without gastroenteroanastomosis).The study of tumor cryofixation as a stage preceding its mobilization and removal in potentially resectable pancreatic cancer was started in 2016. Today the study includes 21 patient.Results and discussion. The combined surgical strategy with the use of CA improved the results of treatment in patients with unresectable tumor of the pancreas. In the group of patients with CA of residual tumor on the main vessel the 1-, 3-, and 5-year survival was 73, 41 and 18% respectively. The median of survival was 22 months. In the group of patients, who underwent cryodestruction of the unresectable tumor of the pancreas, it was possible to achieve a 3-year (actuarial) survival rate of 17%, and the median of survival - 16 months.Two cycles of cryofixation of resectable solid tumor of the pancreas, using the cryoapplicator with the diameter of 30 mm, and the duration of exposure to the freezing period of 10 min with thesubsequent spontaneous thawing does not guarantee the irreversible destruction of all tumor cells at the depth from 3 to 18 mm from the working surface of the cryoapplicator.Conclusions. The use of cryo-technologies lets to increase the radicality of surgical interventions, to improve early and long-term results of treatment of pancreatic cancer.