OPTIMIZATION OF TREATMENT OF PATIENTS WITH PANCREATIC CANCER COMPLICATED BY MECHANICAL JAUNDICE

Abstract

Summary. The aim of the study was to improve the results of surgical treatment of patients with malignant neoplasms of the pancreas complicated by mechanical jaundice, as well as to prove the feasibility of combined treatment and staged approach to it using minimally invasive technologies. Materials and methods of the study. The results of treatment of 112 patients with pancreatic cancer who were treated in the surgical department of the Municipal non-commercial enterprise of the Kharkov regional council «Regional Clinical Hospital» from 2018 to 2021 were analyzed. The age of the examined patients averaged (53,2 ± 12,7) (from 37 to 88 years), of which women — 43 (38,0 %), men — 69 (62,0 %). All patients were examined in the laboratory and instrumentally. Results of the study. Mechanical jaundice was observed in 81 (72,0 %) patients. According to the classification of VE Smirnov (1974), in 16 (14,2 %) patients acute jaundice was observed, in 56 (50 %) — acute prolonged and in 40 (35,8 %) — chronic mechanical jaundice. Among the results of the study of the analyzed patients, the minimum level of total bilirubin in mechanical jaundice was 44 μmol/l, the maximum — 546 μmol/l. All patients with mechanical jaundice underwent endoscopic retrograde cholangiopancreatography. Eight (9,8 %) patients developed complications after endoscopic retrograde cholangiopancreatography: bleeding from a papillotomy wound (4), clinic of acute pancreatitis (3), injury of the posterior wall of the duodenum (1). In 2 cases, the procedure failed due to total obstruction of the large duodenal nipple. Among the 79 patients who managed to undergo endoscopic intervention, only 5 cases, according to the commission on cancer care, were recognized as resectable in the future. Conclusions. Minimally invasive methods of restoring bile in mechanical jaundice caused by cancer of the pancreas are effective as independent treatment procedures, staged, which may precede laparotomy.