Эволюция лечения рака большого сосочка двенадцатиперстной кишки

Автор: Назарова Д.В., Расулов Р.И., Зубринский К.Г., Сонголов Г.И.

Журнал: Сибирский онкологический журнал @siboncoj

Статья в выпуске: 1 т.20, 2021 года.

Бесплатный доступ

Рак большого сосочка двенадцатиперстной кишки (БСДК) не является распространенным новообразованием, он встречается в 6 наблюдениях на 1 млн населения. Диагностика включает методы эндоскопической, рентгенконтрастной и лапароскопической визуализации, морфологическое исследование. При этом отсутствуют специфические биохимические исследования, опухолевые маркеры, не разработан алгоритм ранней диагностики рака БСДК. Панкреатодуоденальная резекция остается основным методом лечения пациентов с резектабельным опухолевым процессом. Однако отдаленные результаты радикальных операций остаются неудовлетворительными; медиана выживаемости составляет 52-113 мес, 5-летняя выживаемость - 30-78,8 %. Изучение факторов прогноза позволит разработать эффективные схемы радикального лечения, что неизбежно увеличит продолжительность жизни. Из всего многообразия факторов прогноза особый интерес представляет морфологическая дифференцировка опухоли. По нашим данным, общая 5-летняя выживаемость, средняя продолжительность жизни при панкреатобилиарном и кишечном подтипах рака БСДК после расширенной панкреатодуоденальной резекции составила 0 % против 38,05 % и 9,3 ± 1,79 мес против 48,0 ± 7,69 мес соответственно. Точный морфологический диагноз имеет важное прогностическое значение, поскольку он является основанием для назначения персонифицированного нео- или адъювантного лечения в соответствии с подтипами рака БСДК. Мультимодальные методы лечения рака БСДК находятся на этапе становления, данные по применению адъювантной терапии противоречивы. Рандомизированных контролируемых исследований по неоадъювантному лечению нет. Мало внимания уделено осложнениям неоадъювантной лучевой и химиотерапии. По нашим данным, при химиоэмболизации желудочно-двенадцатиперстнокишечной артерии осложнения наблюдались в 21,4 %, при дистанционной лучевой терапии - в 25 % случаев. В настоящее время NCCN и ESMO не дают рекомендаций по нео- и адъювантному лечению рака большого дуоденального соска.

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Рак большого сосочка двенадцатиперстной кишки, неоадъювантная и адъювантная терапия, радикальные хирургические вмешательства

Короткий адрес: https://sciup.org/140254449

IDR: 140254449 | DOI: 10.21294/1814-4861-2021-20-1-141-148

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