Obstructive jaundice syndrome caused by hepato-bilio-pancretic cancers - diagnostic and treatment options

Abstract

Introduction: Hepato-bilio-pancreatic cancers are a widely spread pathology. The obstructive jaundice syndrome is one of the most common clinical manifestation of these malignancies, representing, in some cases, the first and the principal complaint of the patient. This fact determines the high importance given to the correct diagnosis procedure, which can be followed by the optimal treatment strategy. Objective: The goal of this study was to evaluate the particularities in diagnostic and surgical treatment options in patients with obstructive jaundice syndrome caused by hepato-bilio-pancreatic cancers. Methods: The study group consisted of 56 patients (mean age 63.85±3.8 years), who presented obstructive jaundice syndrome due to hepato-bilio-pancreatic cancers, hospitalized in different sections of “St. Arhanghel Mihail” Hospital and Republican Clinical Hospital, Moldova, during the period of 2010­ 2011. All the diagnostic procedures, including laboratory tests and imaging techniques were analyzed in order to determine their informativity. Also, the imaging techniques of diagnostic were compared in order to establish their reliability for determining the resectability degree. Regarding surgical procedures, our study analysed the types of operations that have been used, determining their frequency and indications. Results: A useful diagnostic procedure during our study was found to be the biological tests, which showed an hyperbilirubinaemia (mean value 200±28.6 mkMol/L) and an significant elevation of the alkaline phosphatase (3 times higher then the normal value) in all the patients. Also, a useful procedure was the ultrasonography, showing a dilatation of the biliary tract in 94.6% of the cases, being the imaging technique that directed the diagnostic process towards the idea of obstructive jaundice. Finally, the most informative imaging diagnostic technique was the computer tomography (CT), that confirmed the presence of a hepato-bilio-pancreatic cancer in 95.2% of the cases, and the magnetic resonance imaging (MRI), that established the correct diagnosis in 100% of the cases. Regarding the surgical treatment options, it was found that in 92.8% of the cases palliative interventions were accomplished because of late presentation of the patients and aggressive evolution of the disease. Conclusions: Clinical complaints, biological tests and ultrasonography were determined as the more useful diagnostic techniques in the initial differentiation process between the benign and the malign obstructive jaundice syndrome. CT and MRI were found to be the most informative techniques that established the correct diagnosis and determined the direction of the surgical treatment strategy.