P-156 Biliary drainage in patients with extrahepatic bile ducts cancer and obstructive jaundice

Abstract

Introduction: The malignant stenosis of extrahepatic bile ducts mostly affect confluence of the right and left hepatic duct (Klatskin tumors), followed by adenocarcinomas with distal location (periampullary tumors) and tumors of middle part. Biliary drainage is an important part of the treatment of extrahepatic bile ducts tumors. There are some contradictions on different types and methods of resolving the obstructive jaundice. To present and analyze the results of the application of different types of biliary drainage in patient with malignant stenosis of extrahepatic bile ducts, admitted in the Department of General and Hepato-pancreatic Surgery, University Hospital “Alexandrovska”, Sofia, Bulgaria for a period of 6 years. Methods: Between 2009-2014 year in the Department of General and Hepato-pancreatic Surgery were treated 64 patients with extrahepatic bile duct cancer, complicated with obstructive jaundice. The distribution of men to women is 1.37:1. The average age is 64 years. According to the classification of Longmire with perihilar tumors were 31 patients, middle part of the biliary tract was affected in 2 patients and 31 patients was with distal part lesions (10 with adenocarcinoma of common bile duct and 21 with adenocarcinoma of papilla Vateri). According to the classification of Bismuth-Corlette, with type I was two patients, with type II – 3, with type IIIa – 3, with type IIIb – 2, with type IV - 21. The methods used for biliary drainage in radical surgery (18 patients or 11.52%) were: tumor resection with bilio-digestive anastomosis with or without protective biliary drainage. In palliative surgery (25 patients or 16%) were administered: transtumoral internal/external biliary drainage (15 patients), internal biliary drainage (8 patients), external biliary drainage (2 patients). In 15 patients were administered percutaneous transhepatic external / internal-external biliary drainage and 1 - endoscopic prosthesis. In 5 patients obstructive jaundice was treated conservatively. Results: In 55 patients (85.9%) obstructive jaundice is resolved. During hospitalization, death occurred in 9 patients (29.03%). Complications were detected in 11.5%: insufficiency of the anastomosis, drainage obstruction, bleeding of the drainages, pancreatitis, cholangitis, wound infection. There is disagreement in opinions about preoperative biliary drainage in radical surgery. In advanced disease and contraindications for radical surgery, palliative biliary drainage is justified in order to improve the quality of life and reduce the pruritus. Conclusion: Management of obstructive jaundice in patient with malignant stenosis of extrahepatic bile ducts is an essential part of the complex treatment. More research is needed to assess the place and role of different types of biliary drainage.