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

Abstract

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.