Palliative Surgical Treatment of Unresectable Tumors of the Head of the Pancreas Complicated by Mechanical Jaundice and Duodenal Obstruction by Stenting of the Biliary System and Duodenum With Nitinol Stents

Abstract

Summary. The development of new technological solutions for palliative surgical treatment of patients with unresectable pancreatic cancer is relevant because the frequency of postoperative complications in such patients reaches 25 % and mortality — 20 %.
 Objective. Improve the diagnosis and immediate results of palliative surgical treatment of patients with unresectable pancreatic cancer complicated by mechanical jaundice and duodenal obstruction.
 Materials and methods. A comparative analysis of the results of surgical treatment of two groups of patients (11 patients in the first and 27 in the second) for unresectable pancreatic cancer complicated by mechanical jaundice and gastric evacuation disorders due to duodenal obstruction. Patients of group I performed only biliodigestive shunting by open surgery. Patients in group II obstruction of the bile ducts and duodenum was removed by endoscopic stenting of the biliary system and duodenum with nitinol stents.
 Results. It is proved that endoscopic stenting of the biliary system and duodenal obstruction by nitinol stents, compared with open surgery, is accompanied by a lower frequency of postoperative complications (72.7 % vs. 22.2 %, p < 0.05), mortality (27.3 % vs. 0 %, p < 0.001) and reduction of hospital stay (from (24.3 ± 3.74) to (8.7 ± 0.91) days, p <0.001).
 Conclusions. The operation of choice of palliative surgical treatment of patients with unresectable pancreatic cancer complicated by mechanical jaundice and evacuation disorders from the stomach, with a high risk of surgery (ASA III), is to perform endoscopic transpapillary stenting of the bile ducts and duodenum.