Authors
Sementsov K.V.1, 2, Glushkov N.I.1, 2, Boyarinov D.Yu.1, 2, Buranov V.E.1, Myanzelin M.N.1, Fomenko E.E.1, Laushkin M.A.1, 2
1 The Saint Petersburg «Hospital for war veterans», Saint-Petersburg
2 NWSMU named after I. I. Mechnikov, St. Petersburg
Abstract
In recent years, due to the accumulation of long-term results of various types of surgical interventions in the pancreaticoduodenal region, the question of the correct tactics of management of patients with primary unresectable periampullary tumors has been raised more often in the medical community. Such patients need palliative treatment consisting in biliary tract decompression, which can improve the patient’s condition by reducing mechanical jaundice and pruritus, as well as increase the probability of survival by reducing the level of total bilirubin. Thus, together with the widespread introduction of minimally invasive interventions, endoscopic biliary stent placement during ERCPG is now recognized as the gold standard for the treatment of these patients. However, due to the development of modern polychemotherapy schemes, accumulation of distant results regarding complications and survival of patients after different methods of biliary tract decompression, the statement about the greatest efficacy of endoscopic methods is questionable. Indeed, due to the increase of patients’ life expectancy the number of complications has also increased. As a result recurrent jaundice and cholangitis requiring repeated hospitalizations with subsequent reconstructive interventions develop.
Having analyzed the available data published in recent years in different countries, we can conclude that in some cases bypass operations are not inferior to minimally invasive interventions, and sometimes, on the contrary, have a number of advantages. In this review, we have extensively collected data comparing the efficacy of endoscopic and bypass surgeries for the treatment of inoperable patients diagnosed with periampullary cancer.
Keywords: periampullary tumors, cancer of the pancreas, cancer of the terminal choledochus, cancer of the great duodenal papilla, shunt operations, methods of biliary decompression.
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