Postoperative recurrence of pancreatic cancer is one of the main causes of postoperative death. Due to the risk and difficulty of surgery, most of them adopt conservative treatment plus supportive therapy, and the natural course of the patient’s disease is about 1-3 months before he/she dies.
Our practical experience is to use a combined thoracoabdominal incision in all cases, and the rate of reoperative resection can be more than 80%. The reasons for failure to resect are tumor involvement of the aorta, invasion of the liver or pancreas, and frozen fusion of retroperitoneal lymph nodes. The operative mortality rate is about 5% and the complication rate is about 23%. Postoperative follow-up revealed that patients with recurrence of pancreatic cancer who obtained reoperation after surgery survived for more than 1 year with a survival rate of 70% and a median survival of 21 months.
For this group of patients, our experience is to emphasize review every 3 months for up to 1 year after surgery and every 6 months after 1 year. If postoperative dysphagia, chest and back pain, and vomiting of blood and black stool occur again, the possibility of recurrence should be considered. The diagnosis is mainly based on barium X-ray esophagus and fiberoptic gastroscopy. Once the diagnosis is clear, active treatment measures are required, and surgical resection is possible as much as possible again.
In terms of specific treatment, most patients have undergone multiple chemotherapy treatments after the first operation, postoperative anastomotic reflux and stenosis, poor digestion of the residual stomach can lead to long-term malnutrition and electrolyte disorders, and reoperation due to the long and traumatic operation time of thoracoabdominal adhesions, so the incidence of postoperative complications after reoperation is high. In this regard, our experience is to make adequate preoperative preparation, including: 1. nutritional support; 2. preoperative protein or plasma transfusion for those with hypoproteinemia; 3. small and multiple blood transfusions for anemic patients; 4. electrolyte disorders are actively corrected. Postoperatively, strengthen intravenous nutritional support; strengthen respiratory management.