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Solodky VA, Kriger AG, Gorin DS, Dvukhzhilov MV, Akhaladze GG, Goncharov SV, Panteleev VI, Shuinova EA. [Pancreaticoduodenectomy - results and prospects (two-center study)]. Khirurgiia (Mosk) 2023:13-21. [PMID: 37186646 DOI: 10.17116/hirurgia202305113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To summarize the results of pancreaticoduodenectomy (PD) for pancreatic tumors and complications of chronic pancreatitis regarding prediction and prevention of postoperative complications. MATERIAL AND METHODS There were 336 PD procedures between 2016 and mid-2022 in two centers. We assessed the factors influencing specific postoperative complications (postoperative pancreatitis, pancreatic fistula, gastric stasis, arrosive bleeding). Several risk factors were distinguished: baseline pancreatic disease and tumor size, CT-signs of a «soft» gland, intraoperative assessment of the pancreas, number of functioning acinar structures. We assessed surgical prevention of pancreatic fistula via preserving adequate blood supply to the pancreatic stump. The last one is provided by extended pancreatic resection and reconstructive stage of surgery, i.e. Roux-en-Y hepatico- and duodenojejunostomy with isolation of pancreaticojejunostomy on the second loop. RESULTS Postoperative pancreatitis underlies specific complications after PD. The risk of pancreatic fistula in case of postoperative pancreatitis increases by 5.3 times compared to patients without pancreatitis. Postoperative pancreatic fistula is more common in patients with T1 and T2 tumors. According to univariate analysis, only pancreatic fistula significantly affects the risk of gastric stasis. Among 336 people who underwent PD, pancreatic fistula occurred in 69 patients (20.5%), gastric stasis - in 61 (18.2%), pancreatic fistula complicated by arrosive bleeding - in 45 (13.4%) patients. Mortality rate was 3.6% (n=15). CONCLUSION Modern prognostic criteria are valuable to predict specific complications after PD. A promising way to prevent postoperative pancreatitis can be extended pancreatic resection considering angioarchitectonics of the pancreatic stump. Roux-en-Y pancreaticojejunostomy is advisable to reduce aggressiveness of pancreatic fistula.
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Affiliation(s)
- V A Solodky
- Russian Research Center of Radiology, Moscow, Russia
| | - A G Kriger
- Russian Research Center of Radiology, Moscow, Russia
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - D S Gorin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - M V Dvukhzhilov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - G G Akhaladze
- Russian Research Center of Radiology, Moscow, Russia
| | - S V Goncharov
- Russian Research Center of Radiology, Moscow, Russia
| | - V I Panteleev
- Russian Research Center of Radiology, Moscow, Russia
| | - E A Shuinova
- Russian Research Center of Radiology, Moscow, Russia
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Gorin DS, Kriger AG, Galkin GV, Raevskaya MB. [Postoperative pancreatitis after pancreatoduodenectomy]. Khirurgiia (Mosk) 2022:11-16. [PMID: 35146994 DOI: 10.17116/hirurgia202202111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Retrospective assessment of the influence of postoperative pancreatitis in development of pancreatic fistula. MATERIAL AND METHODS The study included 173 patients after pancreatoduodenectomy performed between 2016 and 2019. Postoperative pancreatitis within the 1st postoperative day was verified considering blood amylase > 125 U/L. Patients with postoperative pancreatitis (n=36) were included in the main group, the control group consisted of 137 patients without pancreatitis. Postoperative pancreatic fistula was determined according to the ISGPS 2016 classification. Statistical analysis of the effect of postoperative pancreatitis on development of pancreatic fistula was carried out using relative risk and odds ratio with 95% confidence interval in both groups. RESULTS Postoperative pancreatitis occurred in 36 (20.8%) out of 173 patients after pancreatoduodenectomy. Pancreatic fistula occurred in 18 (50%) cases. Among 137 patients without postoperative pancreatitis, only 18 (13.1%) patients developed severe pancreatic fistula. Relative risk was 3.8 (95% CI 2.22-6.51, p<0.0001), odds ratio - 6.6 (95% CI 2.91-15.01, p<0.0001). CONCLUSION Postoperative pancreatitis significantly influences development of severe pancreatic fistula.
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Affiliation(s)
- D S Gorin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A G Kriger
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - G V Galkin
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - M B Raevskaya
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Alekyan BG, Lusnikov VP, Varava AB, Kriger AG. [Endovascular treatment of arterial bleeding after pancreatic surgery]. Khirurgiia (Mosk) 2021:76-83. [PMID: 34363449 DOI: 10.17116/hirurgia202108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pancreatic surgery is complex and associated with a risk of complications including bleeding. Bleeding after pancreatic surgery is rare, but characterized by high mortality. This review is devoted to classification, diagnosis and treatment strategies for bleeding after pancreatic surgery. Methods and results of endovascular surgery are of special attention.
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Affiliation(s)
- B G Alekyan
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V P Lusnikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A B Varava
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A G Kriger
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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Zharikov YO, Zemlyakova SS, Kiseleva YV, Zharikova TS, Antonyan SG, Tupikin KA, Nikolenko VN. Pancreatic Cancer: Statistics And Treatment In The Russian Federation. RUSSIAN OPEN MEDICAL JOURNAL 2020. [DOI: 10.15275/rusomj.2020.0415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pancreatic cancer (PC) is one of the most fatal types of oncological disease in the world and is an extremely aggressive cancer with a poor prognosis. The objective of this review was to analyze the domestic data of the incidence of PC in the Russian Federation and to analyze the protocols that are used for the management of this group of patients in Russian clinical centers. For the analysis of the literature sources, the data in the elibrary.ru database published in the period from 2015 to 2019 were used. The methodology that was used in each study was examined in order to ensure its reliability, and these data were selected as potential sources of evidence for the preparation of national recommendations. The study results influence the level of evidence assigned to the publication. Updates to the national recommendations are conducted at least once every three years, and these updates depend on new information about the diagnosis and management of patients with PC.
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Kriger AG, Gorin DS, Kaldarov AR, Galkin GV. [Prevention of pancreatic fistula after pancreatoduodenectomy]. Khirurgiia (Mosk) 2020:61-65. [PMID: 33210509 DOI: 10.17116/hirurgia202011161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Prospective randomized investigation of the efficiency of somatostatin analogues and glucocorticoids in pancreatic fistula prevention after pancreatoduodenectomy by using. MATERIAL AND METHODS In period from December 2018 till March 2020 78 patients underwent pancreatoduodenectomy for pancreatobilliary tumors in department of abdominal surgery of National Medical Research Center of Surgery named after A.V. Vishnevsky. Intraoperative frozen section investigation of pancreatic functioning acinar structures (FAS) was held for all patients. 38 patients had more than 40% of FAC and were related with high risk of pancreatic fistula (PF), while 40 patients with less than 40% FAC were included in low risk of PF group. In both groups patients were randomized to main and control subgroups. In main subgroup of high risk group patients combination of somatostatin analogues and glucocorticoids was used, while in control subgroup patients received only somatostatin analogue. In low risk of PF group patients of main subgroup preventively got somatostatin analogue, while control group patients had no specific prophylaxis of PF. To assess the effect of drug prophylaxis on the development of pancreatic fistula we used logistic regression models with the inclusion of the drug use factor as an independent variable. RESULTS 25 patients were included in main subgroup of high risk group. Clinically relevant pancreatic fistula (CRPF) developed in 14 (56%) cases. From 13 patients of control subgroup CRPF developed in 5 (38%) cases. In main subgroup of low risk group 18 patients were included and 3 (16%) of them had CRPF. In control subgroup were 22 patients and there were no cases of CRPF. CONCLUSION In our series combination of somatostatin analogue and glucocorticoid didn't show efficiency in prevention of CRPF in high risk patients, although difference between subgroups wasn't statistically significant (p=0.34). In low risk group patients prophylactic use of somatostatin analogue also didn't show decline of CRPF incidence and the difference between subgroups also wasn't statistically significant (p=0.46).
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Affiliation(s)
- A G Kriger
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - D S Gorin
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - A R Kaldarov
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - G V Galkin
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
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Ischenko RV, Lysenko AO. ARTERY-FIRST APPROACH FOR PANCREATODUODENAL RESECTIONS. SAFETY AND ONCOLOGICAL BENEFIT (LITERATURE REVIEW). SURGICAL PRACTICE 2020. [DOI: 10.38181/2223-2427-2020-1-5-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The results of treatment of patients with malignant neoplasms of the biliopancreatoduodenal zone remain unsatisfactory. With this localization, pancreatoduodenal resection (PDR) remains the only radical surgical intervention. It is more advisable to start with non-surgical treatment, in the presence of arterial invasion of magistral vessels. This served as an impetus for the development of approaches to determine the presence of tumor invasion in the superior mesenteric artery at the early stage of the operation. The surgical goal of PDR remains to minimize contact with the tumor prior to mobilization and ligation of the supply vessels, as well as to increase the edge of the resection around the superior mesenteric artery. To achieve this goal, a number of researchers have proposed various approaches to the superior mesenteric artery during pancreatoduodenal resection, combined “artery-first approach”.An analysis of the existing artery-first techniques for pancreatoduodenal resections, as well as their effect on the treatment results of patients with periampullary malignant neoplasms, is carried out. When conducting literary searches, the databases Pubmed, Сochrane, EMBASE were used using the MESH keywords “Pancreaticoduodenectomy” in combination with the phrase “artery first”. During this search, 157 articles were found. After further analysis, 53 scientific papers were included in the literature review.Modern studies show a decrease in intraoperative blood loss, a decrease in the frequency of postoperative pancreatic fistulas and gastrostasis, as well as an increase in the frequency of R0 resection when this approach is followed. An unambiguous conclusion about the effectiveness of the artery first accesses when performing pancreatoduodenal resection requires further well-planned randomized clinical trials with a large number of patients.
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Affiliation(s)
- R. V. Ischenko
- Federal State Budgetary Unit «Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency»
| | - A. O. Lysenko
- Federal State Budgetary Unit «Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency»
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Gorin DS, Kriger AG, Galkin GV, Kalinin DV, Glotov AV, Kaldarov AR, Galchina YS, Berelavichus SV. [Predicting of pancreatic fistula after pancreatoduodenectomy]. Khirurgiia (Mosk) 2020:61-67. [PMID: 32736465 DOI: 10.17116/hirurgia202007161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Identifying the opportunity of objective prognosis of pancreatic fistula emergence after pancreatoduodenectomy. MATERIAL AND METHODS In the department of abdominal surgery in 2016-2019, 177 pancreatoduodenectomies for pancreatobiliary tumors were performed. 4 risk factors were identified: type of tumor, preoperative CT with an accumulation coefficient in the pancreas of more than 1, soft pancreas, the number of functioning acinar structures identified during intraoperative histological examination. Statistical data processing and predictive modeling were performed using a binary logistic regression model. RESULTS Clinically significant pancreatic fistula was developed in 47 (26,6%) patients. Risk indicators for the occurrence of pancreatic fistula depending on the presence or absence of risk factors were obtained. Groups of patients were identified that require various preventive and therapeutic measures aimed to treat postoperative pancreatitis and its consequences. CONCLUSION Predicting the pancreatic fistula emergence allows to take timely preventive and therapeutic measures, both minimal and aggressive (early extracorporeal detoxification, pancreatectomy), which may lead to complications. Well-reasoned pancreatectomy and extracorporeal detoxification is a surgeon's defense in an insured case or legal conflict.
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Affiliation(s)
- D S Gorin
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - A G Kriger
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - G V Galkin
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - D V Kalinin
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - A V Glotov
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - A R Kaldarov
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - Yu S Galchina
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
| | - S V Berelavichus
- National Medical Research Center of Surgery named after A.V. Vishnevsky of Ministry of health of the Russian Federation, Moscow, Russia
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Zakharova MA, Smirnov AV, Gorin DS, Vorobyeva EA, Kriger AG. [Quality of life as an efficiency index of surgical treatment of chronic pancreatitis]. Khirurgiia (Mosk) 2019:42-51. [PMID: 31714529 DOI: 10.17116/hirurgia201911142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To evaluate quality of life in long-term postoperative period in patients with chronic pancreatitis. MATERIAL AND METHODS There were 31 (21 males and 10 females) patients with complicated forms of chronic pancreatitis who underwent surgery in 2015-2017. Mean age was 49 (44; 53) years, body mass index - 22.4 (20.4; 24) kg/m2. HR-QOL was determined using the questionnaires SF-36, QLQ EORTS C30, VAS. Postoperative control was made no earlier than 6 months after surgery. Median follow-up 11.5 months. The data were analyzed using non-parametric methods. Quantitative data are shown as median with interquartile range. Differences between quantitative values were determined using the Mann-Whitney test. RESULTS Physical status value (SF-36) before surgery was 30.5 (24.8; 37.5), after surgery - 50.8 (46.7; 56.5). Mental status value was 30.2 (26.7; 36.4) prior to surgery and 53.8 (48.7; 57.3) after operation. Improvement of QoL (QLQ C30) from 29.17 (0; 50.0) before surgery to 75.0 (54.2; 83.3) after operation was observed. VAS-score of pain severity was 8 (8; 10) prior to surgery and 3 (2; 5) after surgery. Differences were significant (p<0.05). CONCLUSION Surgical treatment of complicated chronic pancreatitis significantly reduces pain and improves HR-QoL. However, recurrent symptoms of chronic pancreatitis in long-term period cannot be excluded due to short follow-up period (median less than one year). The further investigation is needed.
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Affiliation(s)
- M A Zakharova
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A V Smirnov
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - D S Gorin
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - E A Vorobyeva
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A G Kriger
- Vishnevsky National Medical Research Center for Surgery of the Ministry of Health of the Russian Federation, Moscow, Russia
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Kriger AG, Karmazanovsky GG, Smirnov AV, Kharazov AF, Gorin DS, Raevskaya MB, Galkin GV, Revishvili AS. [Diagnosis and treatment of pancreatic head cancer followed by mesenteric-portal vein invasion]. Khirurgiia (Mosk) 2018:21-29. [PMID: 30560841 DOI: 10.17116/hirurgia201812121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To evaluate the outcomes of pancreaticoduodenectomy with mesenteric-portal vein resection for pancreatic head cancer. MATERIAL AND METHODS Retrospective analysis included 124 patients with pancreatic head cancer for the period 2010-2017. Mesenteric-portal vein (MPV) invasion was diagnosed in 37 (29.8%) patients, tumor contact with superior mesenteric artery as a borderline resectable state was noted in 11 cases. All patients underwent pancreaticoduodenectomy with mesenteric-portal vein resection. RESULTS Vein invasion was histologically confirmed in 19 (51.3%) out of 37 patients. At the same time, arterial invasion was absent in 11 patients with a borderline resectable tumor. CT-associated overdiagnosis of venous wall invasion was 6.4%, intraoperative overdiagnosis - 87.5%. R0-resection was achieved in 88.5% after conventional pancreaticoduodenectomy and in 78.4% after pancreaticoduodenectomy followed by MPV resection. Median survival was 17 months, 2-year survival - 41%. Among 11 patients with a borderline resectable tumor median survival was 11 months. Pancreaticoduodenectomy without vein resection was followed by 2-year survival near 68.1%. Differences were significant (p=0.02). CONCLUSION Pancreaticoduodenectomy followed by MPV resection as the first stage of combined treatment of pancreatic head cancer is absolutely justified if circumferential involvement of the vein and contact with superior mesenteric artery or celiac trunk do not exceed 50%. Vein resection can provide R0-surgery in these cases.
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Affiliation(s)
- A G Kriger
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
| | - G G Karmazanovsky
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
| | - A V Smirnov
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
| | - A F Kharazov
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
| | - D S Gorin
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
| | - M B Raevskaya
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
| | - G V Galkin
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
| | - A Sh Revishvili
- Vishnevsky National Medical Research Center of Surgery of Healthcare Ministry of Russia, Moscow, Russia
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Revishvili AS, Kriger AG, Vishnevsky VA, Smirnov AV, Berelavichus SV, Gorin DS, Akhtanin EA, Kaldarov AR, Raevskaya MB, Zakharova MA. [Current issues in pancreatic surgery]. Khirurgiia (Mosk) 2018:5-14. [PMID: 30307415 DOI: 10.17116/hirurgia20180915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To present own experience of pancreatic surgery and to analyze literature data for this issue. MATERIAL AND METHODS We have analyzed work of abdominal surgery department over the last 5 years. Moreover, MEDLINE and RSCI databases regarding surgical treatment of pancreatic diseases were assessed. RESULTS There were 456 pancreatectomies. Postoperative complications arose in 176 (38.6%) patients, 11 patients died (2.4%). According to world data, mortality after pancreatectomy reaches 10%. Only creation of specialized centers is proven way to improve the outcomes. CONCLUSION Current medical assistance for pancreatic disease may be only achieved in specialized centers with large number of various pancreatic procedures. The organization of such centers is required throughout the country and certain accreditation criteria should be developed for this purpose. Targeted routing of patients to specialized pancreatology centers will be able to reduce incidence of diagnostic, tactical and technical errors.
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Affiliation(s)
- A Sh Revishvili
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - A G Kriger
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - V A Vishnevsky
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - A V Smirnov
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - S V Berelavichus
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - D S Gorin
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - E A Akhtanin
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - A R Kaldarov
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - M B Raevskaya
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
| | - M A Zakharova
- Vishnevsky National Medical Research Center of Surgery, Healthcare Ministry of the Russian Federation Moscow, Russia
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