Shabunin AV, Ametov AS, Tavobilov MM, Pashkova EYu, Karpov AA, Lantsynova AV, Vengerova EN, Polivtseva AI, Rumer VB. Total duodenopancreatectomy: the role of a multidisciplinary team approach in successful treatment. Case report. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(2):147–152. DOI: 10.26442/00403660.2024.02.202581
Тотальная дуоденопанкреатэктомия: роль мультидисциплинарного командного подхода в успешном лечении
Shabunin AV, Ametov AS, Tavobilov MM, Pashkova EYu, Karpov AA, Lantsynova AV, Vengerova EN, Polivtseva AI, Rumer VB. Total duodenopancreatectomy: the role of a multidisciplinary team approach in successful treatment. Case report. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(2):147–152. DOI: 10.26442/00403660.2024.02.202581
В рамках подготовки к хирургическому лечению все пациенты проходят комплексное обследование с целью выявить и скорректировать сопутствующие заболевания. К редким сопутствующим заболеваниям относят первичную хроническую надпочечниковую недостаточность. В данной работе представлен клинический случай тотальной дуоденопанкреатэктомии у пациентки с первичной хронической надпочечниковой недостаточностью. Периоперационный период, особенно после таких длительных и обширных оперативных вмешательств, не всегда сопряжен с возможностью соблюдения соответствующих протоколов, поэтому всегда необходимо индивидуально ориентироваться на лабораторные показатели и клиническую картину. Важен персонифицированный и мультидисциплинарный подход при периоперационном ведении пациентов со сложной коморбидной патологией.
In order to identify and correct concomitant diseases all patients undergo a comprehensive examination before surgical treatment. Rare concomitant diseases include primary chronic adrenal insufficiency. This clinical case presents the total duodenopancreatectomy in a patient with primary chronic adrenal insufficiency. Available algorithms are not always suitable in the treatment of such patients after surgical interventions, especially long-term and extensive. It is necessary to focus on laboratory parameters and the clinical picture. An individual and multidisciplinary approach to the treatment of patients with comorbid pathologies is important.
Keywords: diabetes mellitus after pancreatectomy, pancreas, total duodenopancreatectomy, exocrine pancreatic insufficiency, intracurrent papillary mucinous tumor, primary chronic adrenal insufficiency
1. Hart PA, Bellin MD, Andersen DK, et al. Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol. 2016;1(3):226-37. DOI:10.1016/S2468-1253(16)30106-6
2. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76(2):182-8. DOI:10.1111/his.13975
3. Jang JY, Kim SW, Ahn YJ, et al. Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann of Surg Oncol. 2005;12:124-32. DOI:10.1245/ASO.2005.02.030
4. Johnston WC, Hoen HM, Cassera MA, et al. Total pancreatectomy for pancreatic ductal adenocarcinoma: Review of the national cancer data base. HPB (Oxford). 2016;18(1):21-8. DOI:10.1016/j.hpb.2015.07.009
5. Stoop TF, Ateeb Z, Ghorbani P, et al. Surgical outcomes after total pancreatectomy: A high-volume center experience. Ann Surg Oncol. 2021;28(3):1543-51.
DOI:10.1245/s10434-020-08957-x
6. Loos M, Al-Saeedi M, Hinz U, et al. Categorization of differing types of total pancreatectomy. JAMA Surg. 2022;157(2):120-8. DOI:10.1001/jamasurg.2021.5834
7. Stoop TF, Ghorbani P, Scholten L, et al. Total pancreatectomy as an alternative to high-risk pancreatojejunostomy after pancreatoduodenectomy: A propensity score analysis on surgical outcome and quality of life. HPB (Oxford). 2022;24(8):1261-70. DOI:10.1016/j.hpb.2021.12.018
8. Scholten L, Stoop TF, Del Chiaro M, et al. Systematic review of functional outcome and quality of life after total pancreatectomy. Br J Surg. 2019;106(13):1735-46. DOI:10.1002/bjs.11296
9. Maker AV, Sheikh R, Bhagia V. Diabetes Control and Complications Trial (DCCT) Research Group. Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia. Langenbecks Arch Surg. 2017;402(6):873-83. DOI:10.1007/s00423-017-1603-8
10. Lund A, Bagger JI, Wewer Albrechtsen NJ, et al. Evidence of extrapancreatic glucagon secretion in man. Diabetes. 2016;65(3):585-97. DOI:10.2337/db15-1541
11. Sun EW, Martin AM, de Fontgalland D, et al. Evidence for glucagon secretion and function within the human gut. Endocrinology. 2021;162(4):bqab022. DOI:10.1210/endocr/bqab022
12. Lund A. On the role of the gut in diabetic hyperglucagonaemia. Dan Med J. 2017;64(4):B5340.
13. Shi H, Jin C, Fu D. Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy. World J Gastroenterol. 2017;23(2):265-74. DOI:10.3748/wjg.v23.i2.265
14. Scholten L, Latenstein AEJ, van Eijck C, et al. Outcome and long-term quality of life after total pancreatectomy (Panorama): A nationwide cohort study. Surgery. 2019;166(6):1017-26. DOI:10.1016/j.surg.2019.07.025
15. Мельниченко Г.А., Трошина Е.А., Юкина М.Ю., и др. Клинические рекомендации Российской ассоциации эндокринологов по диагностике и лечению первичной надпочечниковой недостаточности у взрослых пациентов (проект). Consilium Medicum. 2017;19(4):8-19 [Melnichenko GA, Troshina EA, Yukina MYu, et al. Diagnosis and treatment of primary adrenal insufficiency in adult: a Russian Association of Endocrinology Clinical Practice Guideline (project). Consilium Medicum. 2017;19(4):8-19 (in Russian)].
16. Дедов И.И., Мельниченко Г.А., Фадеев В.В. Клинические рекомендации. Первичная надпочечниковая недостаточность. М. 2021; c. 32-4 [Dedov II, Mel'nichenko GA, Fadeev VV. Klinicheskie rekomendatsii. Pervichnaia nadpochechnikovaia nedostatochnost. Moscow. 2021; p. 32-4 (in Russian)].
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1. Hart PA, Bellin MD, Andersen DK, et al. Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer. Lancet Gastroenterol Hepatol. 2016;1(3):226-37. DOI:10.1016/S2468-1253(16)30106-6
2. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76(2):182-8. DOI:10.1111/his.13975
3. Jang JY, Kim SW, Ahn YJ, et al. Multicenter analysis of clinicopathologic features of intraductal papillary mucinous tumor of the pancreas: is it possible to predict the malignancy before surgery? Ann of Surg Oncol. 2005;12:124-32. DOI:10.1245/ASO.2005.02.030
4. Johnston WC, Hoen HM, Cassera MA, et al. Total pancreatectomy for pancreatic ductal adenocarcinoma: Review of the national cancer data base. HPB (Oxford). 2016;18(1):21-8. DOI:10.1016/j.hpb.2015.07.009
5. Stoop TF, Ateeb Z, Ghorbani P, et al. Surgical outcomes after total pancreatectomy: A high-volume center experience. Ann Surg Oncol. 2021;28(3):1543-51.
DOI:10.1245/s10434-020-08957-x
6. Loos M, Al-Saeedi M, Hinz U, et al. Categorization of differing types of total pancreatectomy. JAMA Surg. 2022;157(2):120-8. DOI:10.1001/jamasurg.2021.5834
7. Stoop TF, Ghorbani P, Scholten L, et al. Total pancreatectomy as an alternative to high-risk pancreatojejunostomy after pancreatoduodenectomy: A propensity score analysis on surgical outcome and quality of life. HPB (Oxford). 2022;24(8):1261-70. DOI:10.1016/j.hpb.2021.12.018
8. Scholten L, Stoop TF, Del Chiaro M, et al. Systematic review of functional outcome and quality of life after total pancreatectomy. Br J Surg. 2019;106(13):1735-46. DOI:10.1002/bjs.11296
9. Maker AV, Sheikh R, Bhagia V. Diabetes Control and Complications Trial (DCCT) Research Group. Perioperative management of endocrine insufficiency after total pancreatectomy for neoplasia. Langenbecks Arch Surg. 2017;402(6):873-83. DOI:10.1007/s00423-017-1603-8
10. Lund A, Bagger JI, Wewer Albrechtsen NJ, et al. Evidence of extrapancreatic glucagon secretion in man. Diabetes. 2016;65(3):585-97. DOI:10.2337/db15-1541
11. Sun EW, Martin AM, de Fontgalland D, et al. Evidence for glucagon secretion and function within the human gut. Endocrinology. 2021;162(4):bqab022. DOI:10.1210/endocr/bqab022
12. Lund A. On the role of the gut in diabetic hyperglucagonaemia. Dan Med J. 2017;64(4):B5340.
13. Shi H, Jin C, Fu D. Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy. World J Gastroenterol. 2017;23(2):265-74. DOI:10.3748/wjg.v23.i2.265
14. Scholten L, Latenstein AEJ, van Eijck C, et al. Outcome and long-term quality of life after total pancreatectomy (Panorama): A nationwide cohort study. Surgery. 2019;166(6):1017-26. DOI:10.1016/j.surg.2019.07.025
15. Melnichenko GA, Troshina EA, Yukina MYu, et al. Diagnosis and treatment of primary adrenal insufficiency in adult: a Russian Association of Endocrinology Clinical Practice Guideline (project). Consilium Medicum. 2017;19(4):8-19 (in Russian).
16. Dedov II, Mel'nichenko GA, Fadeev VV. Klinicheskie rekomendatsii. Pervichnaia nadpochechnikovaia nedostatochnost. Moscow. 2021; p. 32-4 (in Russian).
1ГБУЗ «Городская клиническая больница им С.П. Боткина» Департамента здравоохранения г. Москвы, Москва, Россия; 2ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*parlodel@mail.ru
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Alexey V. Shabunin1,2, Alexandr S. Ametov1,2, Mikhail M. Tavobilov1,2, Evgeniya Yu. Pashkova*1,2, Alexey A. Karpov1, Aysa V. Lantsynova1, Elina N. Vengerova1,2, Anastasiya I. Polivtseva1,2, Veronica B. Rumer1
1Botkin City Clinical Hospital, Moscow, Russia; 2Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*parlodel@mail.ru