Objective: to analyze short-term and long-term results of one-step surgery in resectable pancreatic head cancer (PHC), complicated by obstructive jaundice. Material and methods. The retrospective analysis of 123 consecutive cases of the surgical treatment of PHC has been performed. Group I (N = 33) consisted of patients with the total bilirubin level up to 100 µmol/l, group II (N = 31) - with the level of total bilirubin of 100-287 µmol/l who had undergone the one-step surgery. Group III (N = 59) included patients having undergone the surgical treatment with preoperative biliary drainage (PBD) in the form of the biliodigestive anastomoses or external drainage, with the total bilirubin level of 125-720 µmol/l. The frequency of postoperative complications, 90-day lethality and the overall survival rate were assessed by the Kaplan-Meier method. Results. The frequency of complications in the patients of groups I, II and III was 42.4, 48.4 and 35.6 %, lethality - 3.0, 3.2 and 6.8 %, respectively (P > 0.05); the 5-year survival rate - 39.7 ± 8.8 %, 30.1 ± 11.8 % and 4.9 ± 3.1 % (P = 0.004). Conclusion. The one-step surgical treatment of PHC with moderately severe obstructive jaundice was not accompanied with the increased frequency of postoperative complications and mortality. The overall survival rates were significantly higher in the patients undergoing the one-step surgery and did not correlate with the total bilirubin levels. The two-step surgery was accompanied by extremely low survival rates. The cancellation of the routine PBD procedure can be considered as one of the ways to improve the long-term outcomes of the PHC treatment.
Objective: to analyze the dynamics of the immediate and long-term results of the treatment of resectable pancreatic head cancer (PHC) for the period from 1989 to 2019. Material and methods. The retrospective analysis of 123 consecutive cases of the treatment of resectable PHC has been performed. During period I (from 1989 to 2000) 11 patients were operated, during period II (from 2001 to 2013) - 72, and period III (from 2014 to 2019) - 40 patients. The structure and frequency rate of postoperative complications, 90-day mortality and the overall survival rate (by the Kaplan-Meier method) have been assessed. Results. The frequency rate of the postoperative complications in I, II, and III periods were 63.6, 48.6, and 52.5%, mortality - 0, 5,6 and 5.0 %, respectively (P > 0.05). The most common complication and cause of death in all the cases were pancreatic fistula. The indicators of the 3-year survival in I, II, and III periods were 10.0 ± 9.5 %, 18.5 ± 4.7 % and 35.3 ± 9.6 %, the median survival - 10, 13, and 22 months, respectively (P = 0.07). Conclusion . A high frequency rate of the postoperative complications with a relatively low rate of the postoperative mortality was observed in all the analyzed periods. Pancreatic fistula prevailed in the structure of the complications and was the cause of death in all the cases. In the last period there was a clear tendency to improve the long-term results of the treatment, which may be due to more active surgical tactics, increased frequency of combined operations with the resection of vessels and proportional decrease in the share of palliative (R2) operations, standardization of the volume of lymph node dissection, an increased proportion of one-stage operations and increasing the number of patients receiving adjuvant chemotherapy.
Objective : to carry out the comparative analysis of clinical and morphological pathologic factors and long-term results of surgical treatment of cancer of the pancreas head (CPH) depending on prior biliary drainage (PBD). Material and methods . 39 patients (group I) were performed single-step surgery, PBD was performed in 41 cases (group II) at a total bilirubin level of more than 200 umol/l. Results . The prevalence of cancer of the pancreas head in the surveyed groups did not differ, patients of groups I and II revealed low-grade ductal adenocarcinoma in 43 and 79 %, respectively (p = 0.003), the survival median was 14 and 13 months, 3-year survival rate was found in 28.9 ± 8.4 and 3.5 ± 3.4 %, 5-year - 19.3 ± 7.9 and 0 % (p = 0.04). Conclusion . It is advisable to expand the indications for single-step surgical treatment for CPH complicated by obstructive jaundice.
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