CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISK
Introduction. The disadvantages of open operations to eliminate biliary obstruction and duodenal obstruction in patients with unresectable pancreatic head cancer are a high incidence of postoperative complications (up to 40%) and mortality (up to 15‒20%). When installing self-expanding metal stents...
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State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department
2025-04-01
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| Series: | Клінічна та профілактична медицина |
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| Online Access: | https://cp-medical.com/index.php/journal/article/view/572 |
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| author | Borys H. Bezrodnyi Ihor V. Kolosovych Ihor V. Hanol Viktor P. Slobodianyk Ihor V. Cherepenko Pavlo V. Chemodanov Yevhenii O. Nesteruk |
| author_facet | Borys H. Bezrodnyi Ihor V. Kolosovych Ihor V. Hanol Viktor P. Slobodianyk Ihor V. Cherepenko Pavlo V. Chemodanov Yevhenii O. Nesteruk |
| author_sort | Borys H. Bezrodnyi |
| collection | DOAJ |
| description | Introduction. The disadvantages of open operations to eliminate biliary obstruction and duodenal obstruction in patients with unresectable pancreatic head cancer are a high incidence of postoperative complications (up to 40%) and mortality (up to 15‒20%). When installing self-expanding metal stents (SEMS), the incidence of complications and mortality varies within 1‒3%. However, during surgical bypass operations, effective drainage of the biliary system and stomach lasts for more than a year, and SEMS are subject to obstruction with the development of cholangitis 6 months after installation.
Aim. To improve the results of palliative surgical treatment of patients with unresectable pancreatic head cancer complicated by obstructive jaundice in cases of high surgical and anesthetic risk.
Materials and methods. The results of palliative surgical treatment of two groups of patients with unresectable pancreatic head cancer complicated by obstructive jaundice with a physical status of ASA-PS III were analyzed. The retrospective cohort (comparison group) included 18 patients who underwent biliary-digestive drainage by open surgical operations. The prospective cohort (main group) included 26 patients who underwent endoscopic stenting of the biliary system with SEMS.
Results. The treatment strategy for patients consists of gradually eliminating biliary and duodenal obstruction, and managing multiorgan failure by implementing an individualized treatment plan for patients developed by specialists from multidisciplinary medical groups. In cases of diagnosis of acute carcinomatous pancreatitis in patients with signs of hypertension of the main pancreatic duct, it is advisable to perform its transpapillary drainage with stenting of the common bile duct. In patients with physical status of ASA-PS III and Karnofsky index ≥70 (2 points on the ECOG scale), chemotherapy with gemcitabine tended to increase survival by 28.2% (p=0.16).
Conclusions. The use of the SEMS biliary system stenting procedure to restore the biliary-digestive bile passage, compared with the traditional surgical technology of biliary-digestive bypass, is accompanied by a reduction in the complication rate by 52.6% (p=0.0007) and mortality by 31.2% (p=0.01). |
| format | Article |
| id | doaj-art-22a5b124980443f7b6434129ce6c2ddb |
| institution | DOAJ |
| issn | 2616-4868 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | State Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative Department |
| record_format | Article |
| series | Клінічна та профілактична медицина |
| spelling | doaj-art-22a5b124980443f7b6434129ce6c2ddb2025-08-20T03:12:27ZengState Institution of Science «Research and Practical Center of Preventive and Clinical Medicine» State Administrative DepartmentКлінічна та профілактична медицина2616-48682025-04-014172310.31612/2616-4868.4.2025.02572CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISKBorys H. Bezrodnyi0Ihor V. Kolosovych1Ihor V. Hanol2Viktor P. Slobodianyk3Ihor V. Cherepenko4Pavlo V. Chemodanov5Yevhenii O. Nesteruk6Bogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineBogomolets National Medical University, Kyiv, UkraineIntroduction. The disadvantages of open operations to eliminate biliary obstruction and duodenal obstruction in patients with unresectable pancreatic head cancer are a high incidence of postoperative complications (up to 40%) and mortality (up to 15‒20%). When installing self-expanding metal stents (SEMS), the incidence of complications and mortality varies within 1‒3%. However, during surgical bypass operations, effective drainage of the biliary system and stomach lasts for more than a year, and SEMS are subject to obstruction with the development of cholangitis 6 months after installation. Aim. To improve the results of palliative surgical treatment of patients with unresectable pancreatic head cancer complicated by obstructive jaundice in cases of high surgical and anesthetic risk. Materials and methods. The results of palliative surgical treatment of two groups of patients with unresectable pancreatic head cancer complicated by obstructive jaundice with a physical status of ASA-PS III were analyzed. The retrospective cohort (comparison group) included 18 patients who underwent biliary-digestive drainage by open surgical operations. The prospective cohort (main group) included 26 patients who underwent endoscopic stenting of the biliary system with SEMS. Results. The treatment strategy for patients consists of gradually eliminating biliary and duodenal obstruction, and managing multiorgan failure by implementing an individualized treatment plan for patients developed by specialists from multidisciplinary medical groups. In cases of diagnosis of acute carcinomatous pancreatitis in patients with signs of hypertension of the main pancreatic duct, it is advisable to perform its transpapillary drainage with stenting of the common bile duct. In patients with physical status of ASA-PS III and Karnofsky index ≥70 (2 points on the ECOG scale), chemotherapy with gemcitabine tended to increase survival by 28.2% (p=0.16). Conclusions. The use of the SEMS biliary system stenting procedure to restore the biliary-digestive bile passage, compared with the traditional surgical technology of biliary-digestive bypass, is accompanied by a reduction in the complication rate by 52.6% (p=0.0007) and mortality by 31.2% (p=0.01).https://cp-medical.com/index.php/journal/article/view/572cancer of the pancreasobstructive jaundiceprosthetics of the biliary systembiliary stentingstenting of the biliary systemsemsbilio-digestive bypass |
| spellingShingle | Borys H. Bezrodnyi Ihor V. Kolosovych Ihor V. Hanol Viktor P. Slobodianyk Ihor V. Cherepenko Pavlo V. Chemodanov Yevhenii O. Nesteruk CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISK Клінічна та профілактична медицина cancer of the pancreas obstructive jaundice prosthetics of the biliary system biliary stenting stenting of the biliary system sems bilio-digestive bypass |
| title | CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISK |
| title_full | CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISK |
| title_fullStr | CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISK |
| title_full_unstemmed | CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISK |
| title_short | CHOICE OF TACTICS FOR PALLIATIVE SURGICAL TREATMENT OF PATIENTS WITH UNRESECTABLE PANCREATIC HEAD CANCER COMPLICATED BY OBSTRUCTIVE JAUNDICE IN CASES OF HIGH SURGICAL AND ANESTHETIC RISK |
| title_sort | choice of tactics for palliative surgical treatment of patients with unresectable pancreatic head cancer complicated by obstructive jaundice in cases of high surgical and anesthetic risk |
| topic | cancer of the pancreas obstructive jaundice prosthetics of the biliary system biliary stenting stenting of the biliary system sems bilio-digestive bypass |
| url | https://cp-medical.com/index.php/journal/article/view/572 |
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