Preoperative biliary drainage for pancreatic cancer

Abstract

Pancreatic cancer is a leading cause of cancer-related morbidity and mortality, but any meaningful improvement in its prognosis remains elusive. The lack of early diagnostic methods means that many patients only present when symptoms develop, such as obstructive jaundice. Once a diagnosis of pancreatic cancer has been made in a patient with obstructive jaundice, then a decision should be made if the patient is a candidate for surgical resection. Patients who are candidates for surgical resection generally do not need preoperative biliary drainage, unless they present with cholangitis, or if they require neo-adjuvant chemotherapy. If preoperative biliary drainage is to be done, then patient factors and local expertise should guide appropriate interventions. The evidence for endoscopic retrograde cholangiopancreatography as a first-line therapy for biliary decompression is strong; However, the use of percutaneous transhepatic biliary drainage as well as endoscopic ultrasound-guided biliary drainage has generally not been found to be inferior. Finally, to ensure ongoing patency and minimize complications, an appropriate self-expanding metal stent should ideally be placed.

One-Step Surgery in Pancreatic Head Cancer Complicated by Obstructive Jaundice

“…Данное осложнение рассматривается как фактор риска развития послеоперационных осложнений, в связи с чем широко применяется предоперационное билиарное дренирование (ПБД) [1,2]. Однако клинические исследования не выявили существенных преимуществ хирургических вмешательств с ПБД в отношении частоты послеоперационных осложнений и летальности по сравнению с одноэтапными операциями [1,3,4,5,6]. Ряд авторов отмечает повышение частоты гнойно-воспалительных осложнений после проведения ПБД, связывая это с инфицированием желчи, частота которого после дренирующих операций достигает 88 % [7].…”