Clinical Effect Analysis Of Intraoperative Radiotherapy In Comprehensive Treatment Of Hepatobiliary And Pancreatic Diseases

Purpose A new technique of surgical resection of hepato-pancreatic malignant tumor combined with intraoperative radiotherapy was developed,and its safety and clinical effects were preliminarily explored.To explore the safe irradiation dose that can be safely used for intraoperative radiotherapy of hepato-pancreatic malignant tumor,to prevent early postoperative recurrence of hepato-pancreatic malignant tumor,to explore new adjuvant treatment methods for effectively reducing early postoperative recurrence of hepato-pancreatic malignant tumor,and to share experience for the formation of a new treatment model for hepato-pancreatic malignant tumor.Methods From October 2017 to March 2020,a total of 6 patients with hepato-pancreatic malignant tumor who underwent surgical resection combined with intraoperative radiotherapy were collected in our department.All patients underwent surgical resection combined with intraoperative radiotherapy,and INTRABEAM surgical stereotactic small acceleration intraoperative system 50 KV low-energy X-ray was used,and the irradiation tools were all plate donors.Intraoperative radiotherapy in pancreatic cancer group included tumor bed,regional lymph nodes,portal vein,upper mesenteric margin and other high-risk areas after tumor resection.The range of intraoperative radiotherapy exposure in the liver cancer group included the surgical resection margin near the portal area of the great vessels,such as portal vein and hepatic artery,the portal vein where the cancer plug was cut open,the tumor bed after tumor resection,and the area which the surgeon believed was prone to recurrence.,using the methods of retrospective analysis of the two groups of patients were retrospectively analyzed operation time,intraoperative blood loss,hospital stay,postoperative intestinal ventilation time,intraoperative and postoperative complications such as postoperative events associated with surgery and IORT evaluation reflect the change of liver function,renal function and other laboratory index,the evaluation of postoperative patients quality of life and health status,and postoperative recurrence of the tumor model,the primary end point is to know the surgical removal of the combined intraoperative radiotherapy in comprehensive therapy of hepatic malignant tumors of pancreas and preliminary clinical effect,safety package live in patients with local recurrence and overall survival and progression-free surial.Results All the 6 patients in the experimental group received surgical resection of tumor combined with intraoperative radiotherapy.Due to intraoperative combined with intraoperative radiotherapy,the operative time was relatively longer compared with the patients in our department who did not receive IORT.The average operative time of patients in the pancreatic malignant tumor group and the liver cancer group was 7.2h and 7.7h,respectively.The average intraoperative blood loss was 767 ml and 933 ml,and all patients had no intraoperative or postoperative blood transfusion therapy.The IORT irradiation dose averaged 12 Gy and 15 Gy,and the irradiation time averaged 22.3min and 18.7min.In the postoperative pancreatic malignant tumor group,1 patient developed chylous fistula,which could be completely cured after symptomatic treatment.The remaining patients did not present IORT related complications,such as gastroparesis,gastrointestinal hemorrhage,biliary fistula,radioactive hepatitis and pancreaticocomplications.In the postoperative malignant liver tumor group,there was 1 patient with severe cirrhosis,who underwent intraoperative right hemihepatectomy,postoperative residual liver could not be compensated,liver insufficiency and massive ascites occurred,which was not directly related to the intraoperative IORT;the remaining patients did not appear postoperative liver and kidney insufficiency,indicating no obvious damage to liver and kidney function after IORT.At the end of follow-up,1 patient in the pancreatic malignant tumor group developed liver metastasis,left rib metastasis and suspected right adrenal metastasis 2 months after surgery,and finally died due to advanced cachexia.In the liver cancer group,there was 1 patient with diffuse liver cancer in the right liver.Due to severe cirrhosis after hepatitis before surgery,postoperative liver insufficiency was found,and finally,multiple hepatic metastases and hepatorenal syndrome occurred 2 months after surgery,resulting in death.No significant local recurrence or distant metastasis was observed in the remaining patients until the end of follow-up,and the progression-free survival(DFS)of the 2 patients in the pancreatic cancer group was 9 months and 18 months,respectively.Progression-free survival(DFS)was 7 months and 17 months,respectively,in the liver cancer group.Conclusions Surgical resection of hepato-pancreatic malignant tumor combined with intraoperative radiotherapy has no significant impact on postoperative recovery and liver and kidney function of patients,and has good safety during and after surgery.Intraoperative radiotherapy dose of about 15 Gy is safe and feasible.IORT as hepatic postoperative adjuvant therapy of malignant tumor of pancreas,although limited in the number of cases and follow-up,is limited by statistics,but according to the existing research and our experience has shown that surgical removal of the joint IORT can relieve the pain of patients with malignant tumor of pancreas in the liver,improve the patient's quality of life,is expected to be a safe and feasible auxiliary treatment.