Acute carcinomatous pancreatitis in patients with pancreatic head cancer complicated by obstructive jaundice

Abstract

The aim — to improve the diagnostic and surgical palliative treatment results in patients with unresectable pancreatic head cancer, complicated by obstructive jaundice with the canceromatous pancreatitis.Materials and methods. A comparative analysis of the various surgical techniques aimed on the bile duct obstruction syndrome correction by biliodigestive shunting in the palliative surgical treatment of patients with unresectable pancreatic head cancer and mechanical jaundice was done. The analysis of the archival material (1st group, n = 155) was performed at the first stage. It was established that although the pancreatic tumour causes obstruction of both the common bile duct and the main pancreatic duct, however, mechanical jaundice was developed in all patients, and obstructive canceromatous pancreatitis only in 8.8 % of patients. The mild forms of pancreatitis were effectively eliminated by routine methods of intensive care. However, in cases of moderate severe pancreatitis (according to the Atlanta‑92 classification, third revision), the state of patients’ health progressively deteriorated, as the mechanical jaundice background developed a life‑threatening multiorgan failure and the biliodigestive bypassing was not sufficient to avoid a postoperative complications and unsatisfactory results in all cases. Based on the obtained results analysis it was concluded that modernization is need to both surgical tactics and techniques in such patients. Therefore, it was planned and carried out original trial with the optimized treating technology approbation for such patients. To this end, 112 patients with pancreatic head cancer, complicated by mechanical jaundice (Group 2), treated in the surgical department for the period of 2007 — 2018 were included in an open, prospective, randomized study.An approbation of the original algorithm for the carcinomatous pancreatitis verification was performed; the effectiveness evaluation of the proposed tactics and the technique of surgical treatment, including the developed method of combined bilio‑ and pancreaticodigestive bypass surgery was done.Results and discussion. The safety and clinical efficacy of simultaneous with biliodigestive pancreatodigestive bypass was established in patients with locally advanced pancreatic head cancer complicated by obstructive jaundice and carcinomatous pancreatitis. The tactics of a two‑stage surgical treatment was described, which involves first performing external cholangiostomy with minimally invasive techniques or endoscopic transpapillary stenting in patients with signs of liver failure or carcinomatosis pancreatitis, and then the main stage of surgical intervention.Conclusions. The proposed tactics of two‑stage surgical treatment in patients with nonresectable pancreatic head cancer complicated by mechanical jaundice and pancreatic cancer, which includes a two stage technology of surgical interventions with the use of minimally invasive operations in the first stage of treatment and one‑step combined bilio‑ and pancreaticodigestive bypass surgery on the second one, contributes to the reduction of postoperative complications, mortality and improves the patients’ life quality.