Total Pancreatoduodenectomy: Clinical Cases

Introduction. Total pancreatoduodenectomy is among the most technically demanding procedures in abdominal surgery, both in terms of operative complexity and perioperative management. It is performed as a necessary alternative to standard pancreatoduodenal resection in cases of intraductal pancreatic cancer with diffuse gland involvement. Aim. This study describes the technical features and perioperative management of patients undergoing total pancreatoduodenectomy.

Material and methods. From 2019 to the present, 99 operations for pancreatic cancer were performed in the First Surgical Department of the Republican Clinical Hospital named after G.G. Kuvatov. These included 14 distal (corporal-caudal) pancreatectomies, 78 pancreatoduodenal resections, and 7 total pancreatoduodenectomies. All seven total pancreatoduodenectomies were performed for pancreatic ductal adenocarcinoma complicated by obstructive jaundice. The initial stage involved percutaneous transhepatic external biliary drainage. Intraoperatively, hemodynamic stability was maintained through transfusion of packed red blood cells, plasma, and crystalloids. Blood glucose was monitored every 60 minutes and maintained between 6.0 and 10.0 mmol/L using short-acting insulin.

Results and discussion. The duration of total pancreatoduodenectomy was significantly longer than that of standard pancreatoduodenal resection (p < 0.05), despite fewer anastomoses. Estimated blood loss was comparable between procedures. One 73-yearold patient died in the early postoperative period due to an acute myocardial infarction. Four patients died during long-term follow-up; two remain under observation at 14 and 4 months without evidence of disease progression. Median survival was 14.2 months. Total pancreatoduodenectomy, performed as a necessary measure in ductal pancreatic cancer with subtotal or total gland involvement, remains a highly traumatic procedure. Nevertheless, advances in surgical technique, anesthesiology, and critical care support justify its use in specialized centers.

Conclusion. Total pancreatoduodenectomy is an extensive and high-risk procedure that can be performed safely in specialized institutions with appropriate surgical and perioperative expertise.

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