Cryodestruction in Locally Аdvanced Pancreatic Cancer
1Radiology, A.V. Vishnevsky National Medical Research Center of Surgery, Russia
2Abdomenal surgery, A.V. Vishnevsky National Medical Research Center of Surgery, Russia
Pancreatic cancer is the fourth-leading cause of cancer death and one of the most difficult malignancies to manage. Because of the usually late onset of symptoms, only 15%–20% of patients present with resectable disease, whereas the remaining patients with locally advanced unresectable or metastatic disease.
THE PURPOSE: Improving the life quality, and increase life expectancy (in combination of chemotherapeutic treatment) in patients with locally advanced pancreatic cancer (LAPC).
MATERIALS AND METHODS: Since January 2012, оpen cryodestruction has been performed in 36 patients with LAPC (male - 14 (38.9%), female – 22 (61.1%). The mean age was 58±6.8 years. Tumor size was 2.5-10 cm. Local destruction was supplemented by bypass anastomoses in 18 (50%) cases. Ultrasonography, CT and/or MRI performed to all patients before surgery. Ultrasonography carried out at intraoperative period too. "CRYO-MT" and "CRYO-01" were used, as well as porous-sponge applicators made of titanium nickelide. The target temperature: -186ºС. Exposure time: 3-5 min. All patients subsequently underwent adjuvant chemotherapy, supplemented with regional chemoembolization in 10 cases.
RESULTS: Stages of US-control and diagnostic characteristics of tissue changes after cryo-effect are defined: 1.navigation; 2."iceball" formation; 3.thawing; 4.after applicator removal.
There were no lethal outcomes during the intervention and in the nearest postoperative period. Complications: intraperitoneal bleeding was - 2 (5.5%); acute pancreatitis - 5 (13.8%); suppuration in the manipulation zone - in 2 (5.5%); ascite - 9 (25%).
After cryodestruction: the complete disappearance of the pain syndrome - 42.2%, a significant decrease in its intensity - 41.6%.
Survival in Kaplan-Meier: 6 months – 92%, 12 – 84%, 24 – 48%, 36 – 14%. Mediana – 18.2.
CONCLUSION: Cryodestruction in patients with LAPC improves the quality of life due to pain relief and increases survival rate in combination with chemotherapy. Ultrasound is an important diagnostic modality in the stages of diagnosis and treatment of such patients.