R1 en pacientes con tumor de páncreas sometidos a intervención quirúrgica en el Hospital Solca en el periodo 2012 al 2016.

Abstract

Introduction: 90% of pancreatic tumors are pancreatic head adenocarcinoma, which have a multifactorial origin with risk factors that predispose cellular alteration. Surgery remains the only potentially curative therapeutic option. The infiltration of the surgical margins (R1) in the operative pieces is a negative and independent factor for the survival of the patients. Method: This retrospective observational study was carried out at the SOLCA Hospital, where a sample universe of 107 clinical histories corresponding to a pancreatic tumor was obtained, of which 43 records were excluded because they were requests for biopsy analysis, 6 which only included the use of Implantofix, 19 in whom exploratory laparotomy plus biopsy was performed, obtaining a final sample of 39 clinical histories that were submitted to surgical intervention with surgical tissues, of which 17 were by Whipple technique and 22 by other types of surgery. Results: Of the 39 operative records reviewed in this study, it was found that 74.5% were submitted to CPD. Twenty -two (56.41%) patients remained alive at the end of the investigation and 17 (43.58%) died. The margins studied in almost all patients (90%) were pancreatic, proximal and distal, while the least informed were biliary margin (reported in 20.5% of the pieces), uncinate and vascular, both in 5.13% each (p = <0.05). Of the margins mentioned above, 33 operative pieces had free margins, and in 5 pieces at least one margin was compromised. Of these, the commitment was evident in pancreatic margins (2 cases), bile (2 cases) and uncinate (1 case). At the time of the post-surgical follow-up, it was verified that 27 patients relapsed, 10 had favorable evolution and 2 patients did not go to their control after surgery. Of the patients who relapsed it was verified that its final status was: 9 alive (33,30%) and 17 died (62,90%). DPC was the most used surgical technique (74.35%). The median overall survival was 13 monthsDiscussion: A 2013 publication of the Autonomous University of Barcelona states that the survival of patients with pancreatic cancer is 3 years in 25% and in 5 years under 10%, we could verify t hat of the 39 cases 27 patients relapsed, being a number Significant since it represents more than half of the sample, it is worth mentioning that of the 27 patients, 17 of them died. Conclusion: Despite the surgical intervention the relapse remains high, this could be due to a lack of protocol consensus in which the number of nodes extracted can be standardized to determine with certainty if there is nodal compromise and to standardize the surgical margins for later study and Determine the percentage of infiltration if applicable. Recommendations: It is recommended that an institutional protocol be developed for pancreatic cancer and its proper use for future investigations.