Results of the application of an improved prognostic and therapeutic algorithm for the provision of radical surgical care to patients with mechanical jaundice of benign and malignant genesis
DOI:
https://doi.org/10.15574/PS.2023.78.88Keywords:
prognosis, preoperative period, postoperative complications, pancreatic cancer, chronic pancreatitis, molecular-genetic studies, mechanical jaundice, pancreatoduodenal resectionAbstract
The problem of improving the results of surgical care for patients with mechanical jaundice syndrome as a complication of pancreaticobiliary cancer and chronic pseudotumor pancreatitis is still being discussed.
Purpose - to improve the results of radical surgical care for patients with pancreaticobiliary cancer and chronic pseudotumour pancreatitis complicated by mechanical jaundice syndrome.
Materials and methods. The results of surgical treatment of 272 patients with mechanical jaundice syndrome were analyzed. The main group included 112 patients who were treated with our own developed prognostic and therapeutic algorithm. The comparison group included 160 patients who underwent preoperative preparation outside this algorithm.
Results. Almost all the patients in the main group had single nucleotide genetic mutations in the PRSS 1 (Arg122His), SPINK 1 (Asn34Ser), TNF (G308A) and CFTR (Phe508del) genes. In patients of the main group, according to ultrasound elastography, the density of pathological focus for pancreatic cancer was 7.5±0.8 units, and for chronic pseudotumour pancreatitis - 5.6±0.5 units (p<0.05). The most significant differences were observed in the frequency of pancreaticodigestive anastomosis failure (c2=6.95; p=0.008) and in the frequency of bleeding in the postoperative period (c2=4.29; p=0.004). The amount of life-threatening postoperative complications was 42 (37.5%) cases in the main group and 102 (63.8%) cases in the comparison group (c2=18.22; df=1; p<0.0001). In the main group 7 (6.3%) patients died, in the comparison group - 19 (11.9%).
Conclusions. Prevention of the development of immediate postoperative complications in patients with focal pathology of the pancreatobiliary zone against the background of mechanical jaundice is achieved by combining molecular genetic studies with the determination of the patient's phenotype, ultrasound fibroelastography and mathematical modelling of patient status.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
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