Choice of Palliative Surgical Biliary Decompression for Inoperable Biliopancreatoduodenal Tumors
https://doi.org/10.16931/1995-5464.2016455-62
Abstract
Aim. To improve the results of palliative surgical treatment of malignant obstructive jaundice by selection of optimal biliary decompression in distal obstruction.
Material and Methods. In the main group (n = 80) choledochojejunostomy was predominantly performed. Gallbladder bypass was used only if choledochodigestive anastomosis was impossible. In the comparison group (n = 92) the method of biliary decompression was determined by surgeon's preferences. Herewith cholecystodigestive anastomosis was also applied in cases when common bile duct bypass was possible.
Results. Choledohodigestive anastomoses were made in 63 (78.8%) and 34 (37%) cases in both groups respectively (p < 0.001). Herewith choledochojejunostomy was performed in 48 (60%) cases in the main group and in 20 (21.7%) patients in the comparison group (p < 0.001). Cholecystodigestive anastomosis was applied significantly less frequently in the main group than in the comparison group (7.5% vs 47.8%, p < 0.001). Morbidity and mortality rates were
comparable in both groups: 23.8% vs 23.9% (p = 0.87) and 8.8% vs 12% (p = 0.67) respectively. In remote postoperative period recurrent jaundice followed by reoperation developed in 1 patient of the main group and in 8 cases of the comparison group (p = 0.029). In 6 patients of the comparison group jaundice was observed after cholecystodigestive
anastomosis. Patients of the comparison group had nausea and vomiting more frequently according to EORTC QLQ C30 questionnaire (40.6 ± 21.3 vs 30.8 ± 17.5, p = 0.012). Itching (8 ± 2.6 vs 9.5 ± 1, p = 0.018) was also more frequent in the comparison group by the visual-analogue scale.
Conclusion. Choledochojejunostomy is advisable for adequate biliary decompression that provides better quality of life. Less efficient operations including cholecystodigestive anastomosis should be applied if other methods are impossible.
About the Author
G. M. Barvanyan
GBUZ of Komi Republic “Komi Republican Hospital
Russian Federation
Cand. of Med. Sci., Head of the Surgical Department of Komi Republican Hospital
Russian Federation
Cand. of Med. Sci., Head of the Surgical Department of Komi Republican Hospital
References
1. Dolgushin B.I., Patyutko Yu.I., Nechipay A.M., Kukushkin A.V. Antegradnye jendobiliarnye vmeshatel'stva v onkologii [Antegrade endobiliary interventions in oncology]. Moscow, 2005. 175 p. (In Russian)
2. Kubachev K.G., Borisov A.E., Isudinov A.S., Khromov V.V., Sagitova D.S. Choice of bile duct decompression in malignant obstructive jaundice. Annaly khirurgicheskoy gepatologii. 2009; 14 (3): 56–62. (In Russian)
3. Smigielski J., Piskorz L., Wawrzycki M., Kutwin L., Misiak P., Brocki M. Assessment of quality of life in patients with nonoperated pancreatic cancer after videothoracoscopic splanchnic ectomy. Wideochir. Inne Tech. Maloinwazyjne. 2011; 6 (3): 132–137. doi: 10.5114/wiitm.2011.24690.
4. Borisov A.E. Rukovodstvo po khirurgii pecheni i zhelchevyvodjashhih putej [Guidelines for liver and biliary surgery]. In 2 volumes, Volume 1. St. Petersburg: Skifija, 2003. 488 p. (In Russian)
5. Rukovodstvo po khirurgii zhelchnyh putej [Guidelines for biliary tract surgery] 2-e izd. Ed. Galperin E.I., Vetshev P.S. Moscow: Vidar-M., 2009. 568 р. (In Russian)
6. Zherlov G.K., Karpovich A.V., Zykov D.V., Krasnoperov A.V., Demakov M.V. Antireflux hepaticojejunostomy in treatment of extrahepatic bile ducts and pancreatic head cancer. Khirurgiya (Moscow). 2009; 3: 17–22. (In Russian)
7. Kim E.H., Kim H.J., Oh H.C., Lee K.H., Jung J.Y., Kim S., Lee S.S., Seo D.W., Kim M.H., Lee S.K. The usefulness of percutaneous transhepatic cholangioscopy for identifying malignancies in distal common corrected bile duct strictures. J. Korean Med. Sci. 2008; 23 (4): 579–585. doi: 10.3346/jkms.2008.23.4.579.
8. Gvozdev A.A., Chigirev V.A., Gusev D.V. Sravnitel'naja ocenka rezul'tatov hirurgicheskogo i jendoskopicheskogo lechenija mehanicheskoj zheltuhi opuholevoj prirody [Comparative evaluation of surgical and endoscopic treatment of malignant obstructive jaundice]. Report of the twentieth Anniversary of the International Congress of surgeons-hepatologists of CIS countries. Donetsk, 18–20 September, 2013. P. 227. (In Russian)
9. Boulay B.R., Parepally M. Managing malignant biliary obstruction in pancreas cancer: Choosing the appropriate strategy. World J. Gastroenterol. 2014; 20 (28): 9345–9353. doi: 10.3748/wjg.v20.i28.9345.
10. Jianfeng Y.U., Jianyu H.O., Dongfang W.U., Lang H. Retrospective evaluation of endoscopic stenting of combined malignant common bile duct and gastric outlet-duodenum obstructions. Exp. Ther. Med. 2014; 8 (4): 1173–1177. doi: 10.3892/etm.2014.1899.
11. Hwang S.I., Kim H.O., Son B.H., Yoo C.H., Kim H., Shin J.H. Surgical palliation of unresectable pancreatic head cancer in elderly patients. World J. Gastroenterol. 2009; 15 (8): 978–982. doi: 10.3748/wjg.15.978.
12. Scott E.N., Garcea G., Doucas H., Steward W.P., Dennison A.R., Berry D.P. Surgical bypass vs. endoscopic stenting for pancreatic ductal adenocarcinoma. HPB. 2009; 11 (2): 118–124. doi: 10.1111/j.1477-2574.2008.00015.x.
13. Buxbaum J.L., Biggins S.W., Bagatelos K.C., Inadomi J.M., Ostroff J.W. Inoperable pancreatic cancer patients who have prolonged survival exhibit an increased risk of cholangitis. JOP. 2011; 12 (4): 377–383.
14. Gouma D.J. Stent versus surgery. HPB. 2007; 9 (6): 408–413. doi: 10.1080/13651820701729986.
15. Danilov M.V., Glabay V.P., Kustov A.E., Gavrilin A.V., Ponomarev V.G., Matveeva G.K., Saidov S.S. Surgical treatment of malignant obstructive jaundice. Annaly khirurgicheskoy gepatologii. 1997; 2: 110–116. (In Russian)
16. Galperin E.I., Dederer Yu.M. Nestandartnye situacii pri operacijah na pecheni i zhelchnyh putjah [Nonstandard situations during liver and biliary operations]. Moscow: Publishing House Medicine, 1987. 335 p. (In Russian)
17. Karpachev A.A., Prokof'yeva A.V. Comparative characteristics of different biliodigestive anastomoses in palliative surgical treatment of pancreaticoduodenal area cancer. Fundamentalnye issledovanija. 2007; 2: 82–84. (In Russian)
18. Zemlyanoy V.P., Nepomnyashchaya S.L., Rybkin A.K. Biliary decompression in malignant obstructive jaundice. Prakticheskaja onkologija. 2004; 5 (2): 85–93. (In Russian)
19. Vogt D.P., Hermann R.E. Choledochoduodenostomy, choledocho jejunostomy or sphincteroplasty for biliary and pancreatic disease. Ann. Surg. 1981; 193 (2): 161–168.
20. Karapanos K., Nomikos I.N. Current surgical aspects of palliative treatment for unresectable pancreatic cancer. Cancers. 2011; 3 (1): 636–651. doi: 10.3390/cancers3010636.
21. Patyutko Yu.I., Kotel'nikov A.G., Dolgushin B.I., Virshke E.R., Kukushkin A.V., Mikhaylov M.M., Kosyrev V.Yu. Zhelcheotvedenie pri mehanicheskoj zheltuhe opuholevogo proishozhdenija [Bile duct decompression in malignant obstructive jaundice]. IV Russian Oncological Conference. Moscow, 2000. P. 74–79. (In Russian)
22. Stefanini P., Carboni M., Patrassi N., Basoli A., de Bernardinis G., Negro P. Roux-en-Y hepaticojejunostomy: A reappraisal of its indications and results. Ann. Surg. 1975; 181 (20): 213–219.
23. Gani J., Lewis K. Hepaticocholecystoenterostomy as an alternative to hepaticojejunostomy for biliary bypass. Ann. R. Coll. Surg. Engl. 2012; 94 (7): 472–475. doi: 10.1308/003588412X13171221592294.
24. Huggett M.T., Ghaneh P., Pereira S.P. Drainage and bypass procedures for palliation of malignant diseases of the upper gastrointestinal tract. Clin. Oncol. (R. Coll. Radiol.). 2010; 22 (9): 755–763. doi: 10.1016/j.clon.2010.08.001.
25. Ubhi C.S., Doran J. Palliation for carcinoma of head of pancreas. Ann. R. Coll. Surg. Engl. 1986; 68 (3): 159–161.
26. Urbach D.R., Bell C.M., Swanstrom L.L., Hansen P.D. Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer. Ann. Surg. 2003; 273 (1): 86–93.
Review
For citations:
Barvanyan G.M. Choice of Palliative Surgical Biliary Decompression for Inoperable Biliopancreatoduodenal Tumors. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2016;21(4):55-62. (In Russ.) https://doi.org/10.16931/1995-5464.2016455-62
Views:
971
Email this article 