Pankreas Cerrahisinde Preoperatif Hasta Yönetimi
Özet
Pankreas cerrahisi, yüksek morbidite ve mortalite oranlarına sahip pankreas kanserlerinde tek küratif tedavi seçeneğidir. Son yıllarda cerrahi komplikasyonlardan ziyade sistemik komplikasyonlar primer mortalite etkeni haline gelmiştir. Preoperatif hasta yönetiminde Bilgisayarlı Tomografi (BT), Manyetik Rezonans (MR) ve Endoskopik Ultrasonografi (EUS) gibi görüntüleme yöntemleri tanı ve evrelendirmede kritik rol oynar. Hastalarda malnütrisyon, anemi ve diyabet sıklıkla görülmekte; HbA1c değerinin 7 ve altında tutulması, oral diyabet ilaçlarının kesilerek insüline geçilmesi önerilmektedir. Preoperatif rutin laboratuvar parametrelerinden BUN değerinin 18 mg/dl'den yüksek, albüminin ise 3.5 g/dl'den düşük olması postoperatif komplikasyon riskini artırır. Kardiyak ve solunum sistemlerinin detaylı değerlendirilmesi, özellikle 70 yaş üstü ve tütün kullanan hastalarda perioperatif riskleri azaltmak için elzemdir. Ameliyat öncesi en az 4 hafta önce sigaranın bırakılması mukosilyer mekanizmaları düzeltir. Geliştirilmiş cerrahi sonrası iyileşme (ERAS) protokolleri; preoperatif dönemde rutin biliyer drenajdan kaçınılmasını, karbonhidrat yüklemesini, multimodal analjezi stratejilerini ve erken mobilizasyonu savunarak postoperatif dönemde komplikasyonları azaltmayı ve hastanın erken toparlanmasını hedefler.
Pancreatic surgery remains the only curative treatment option for pancreatic cancers, which are characterized by high morbidity and mortality rates. Recently, systemic complications rather than surgical ones have become the primary drivers of mortality. In preoperative management, imaging modalities such as Computed Tomography (CT), Magnetic Resonance (MR), and Endoscopic Ultrasonography (EUS) play a critical role in diagnosis and staging. Malnutrition, anemia, and diabetes are frequently observed in these patients; maintaining HbA1c levels at or below 7 and transitioning from oral antidiabetics to insulin is recommended. Preoperative laboratory markers, specifically BUN greater than 18 mg/dl and albumin less than 3.5 g/dl, significantly correlate with increased postoperative complications. Thorough cardiac and pulmonary evaluations are essential to mitigate perioperatif risks, particularly in patients over 70 and chronic smokers. Smoking cessation at least 4 weeks preoperatively restores mucociliary clearance. Enhanced Recovery After Surgery (ERAS) protocols aim to reduce postoperative complications and accelerate recovery by advocating for the avoidance of routine preoperative biliary drainage, promoting carbohydrate loading, implementing multimodal analgesia, and encouraging early mobilization.
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