Determining the risk of pancreatoduodenal resection performing in patients with obstructive jaundice syndrome

Abstract

Background: The main radical surgical treatment of patients with focal lesions of the pancreatoduodenal zone, accompanied by obstructive jaundice, is pancreatoduodenal resection. Aim of the study: To improve the results of radical surgical treatment of patients with focal lesions of the pancreatobiliary zone, complicated by obstructive jaundice. Methods and materials: The results of radical surgical treatment of 272 patients were analyzed. Cancer of the head of the pancreas was verified in 174 (63.9%) of patients, Vater's papilla cancer - in 20 (7.4%), distal choledochal cancer - in 24 (8.8%) and chronic pseudotumoral pancreatitis - in 54 (19, 9%) patients. Results: In each patient the magnitude of the planned operation risk was determined according to the own formula (taking into account the main pathological parameters of the patient’s condition). If the value of the prognostic risk factor for pancreatoduodenal resection performing exceeded the allowable limit (≥ 60), biliary decompression was performed. During pancreatoduodenal resection, a Whipple termino-lateral anastomosis was applied in 38 (13.9%) patients, termino-terminal in 40 (14.7%) cases, pancreatojejunostomy ductomucosal anastomosis - in 128 (47.1 %) cases, pancreatogastrostomy - in 35 (12.9%) cases, sleeve pancreatogastrostomy - in 31 (11.4%) cases. The most frequent complication after PD was the failure of pancreatoenteroanastomosis (type A-B according to ISGPF) - 32 (11.2%). 14 patients died. Mortality rate was 5.1%.