In this paper retrospective treatment result analysis of 386 patients with periampullary cancer, complications are carried out by obstructive jaundice. Patients were organized into two groups: the first group patients to whom traditional surgical interventions were applied, and entered the second – treated with endoscopic transpapillary surgeries. We have shown that at the nonresectable cancer of bodies of a pancreatoduodenal zone complicated by obstructive jaundice, endoscopic transpapillary interventions are the main method of decompression of a biliary tree, thus allowing complete avoidance of traditional surgical intervention

Alkanany, Edrees

Frantsev, Sergey P.

Gnashko, Anjela V.

Gostishev, Victor K.

Iarosh, Andrei L.

Karpachev, Alexander A.

Kulikovsky, Vladimir F.

Oleynik, Natalya V.

Soloshenko, Alexander V.

English

Karpachev, A. A.

Soloshenko, A. V.

Kulikovsky, V. F.

Yarosh, A. L.

Gostishev, V. K.

Frantsev, S. P.

Oleynik, N. V.

Gnashko, A. V.

DSpace at Belgorod State University

262n this paper retrospective treatment result analysis of 386 patients with periampullary cancer, complica-tions are carried out by obstructive jaundice. Patients were organized into two groups: the first group patients to whom traditional surgical interventions were applied, and entered the second – treated with endoscopic transpapil-lary surgeries.  Cancer of a pancreas head is revealed in 177 patients, cancer of a big duodenal nipple in 145 pa-tients and cancer of the terminal department of the gen-eral bilious channel in 64 patients. The duration of bilious channels obstruction was from 3 to 45 days. The presence of obstructive jaundice at this category of patients was considered the indication to performance of endoscopic transpapillary decompressive interventions. We have shown that at the nonresectable cancer of bodies of a pancreatoduodenal zone complicated by obstructive jaun-dice, endoscopic transpapillary interventions are the main method of decompression of a biliary tree, thus allowing complete avoidance of traditional surgical interventions.Keywords: endoscopy interventions, periampullary carci-noma, obstructive jaundice.n este trabajo, el análisis retrospectivo del resultado del tratamiento de 386 pacientes con cáncer periampular, las complicaciones se llevan a cabo por ictericia obstructiva. Los pacientes se organizaron en dos grupos: el primer grupo de pacientes a los que se les aplicaron intervenciones quirúrgicas tradi-cionales y entraron en el segundo, tratados con cirugías transpapilares endoscópicas. El cáncer de cabeza de pán-creas se revela en 177 pacientes, el cáncer de un gran pezón duodenal en 145 pacientes y el cáncer del departa-mento terminal del canal bilioso general en 64 pacientes. La duración de la obstrucción de los canales biliosos fue de 3 a 45 días. La presencia de ictericia obstructiva en esta categoría de pacientes se consideró una indicación para la realización de intervenciones descompresivas transpapila-res endoscópicas. Hemos demostrado que en el cáncer no resecable de los cuerpos de una zona pancreatoduodenal complicada por ictericia obstructiva, las intervenciones transpapilares endoscópicas son el método principal de descompresión de un árbol biliar, lo que permite evitar por completo las intervenciones quirúrgicas tradicionales.Palabras clave: Intervenciones endoscópicas, carcinoma periampular, ictericia obstructiva.Endoscopic surgical interventions in the treatment of periampullary cancerAlexander A. Karpachev1, https://orcid.org/0000-0002-3491-6303, Alexander V. Soloshenko1, https://orcid.org/0000-0002-8543-3723, Vladimir F. Kulikovsky1, https://orcid.org/0000-0002-4722-9334, Andrei L. Iarosh1, https://orcid.org/0000-0001-6365-3496, Victor K. Gostishev1, https://orcid.org/0000-0001-9749-7890, Sergey P. Frantsev1, https://orcid.org/0000-0002-6142-0426, Natalya V. Oleynik1, https://orcid.org/0000-0002-2836-8531, Anjela V. Gnashko1, https://orcid.org/0000-0002-2962-2802, Edrees Alkanany1 https://orcid.org/0000-0003-0194-353X 1Belgorod State University. Pobeda 85, Belgorod, 308015, Russia; *corresponding author: Andrei L. Iarosh, Belgorod State University. Pobeda 85, Belgorod, 308015, Russia. Email: yarosh_a@bsu.edu.ru Intervenciones quirúrgicas endoscópicas en el tratamiento del cáncer periampularResumenAbstracthe widespread introduction in surgical practice of low-invasive technologies for the treatment of patients with diseases of liver, pancreas and bile-excreting channels has allowed to expand consider-ably possibilities of rendering the surgical help to patients without big surgeries11. However, both traditional, and low-invasive interventions have a range of opportunities, therefore, they demand the differentiated approach and definition of indications and contraindications. Questions of indications and the choice of the most perfect ways of “low-invasive surgery” and also relationship between them and the methods of traditional surgery which are carried out by laparotomy access are in the center of a discussion of surgeons, endoscopists, radiologists, special-ists in endosurgery who often express polar opinions and make opposite recommendations3,7. Unfortunately, now no accurate objective criteria are allowing to choose opti-mum surgical tactics of the differentiated treatment in the Introduction263Revista Latinoamericana de Hipertensión. Vol. 14 - Nº 4, 2019www.revhipertension.comtreatment of benign and malignant diseases of bodies of a pancreatoduodenal zone, and these literature demon-strate steady growth of the number of patients with this pathology1,3,6,7,12. he retrospective analysis of results of treatment of 386 patients with periampullary cancer com-plicated by obstructive jaundice who were on treatment in the Center of surgery of a liver of a pancreas of the Belgorod regional clinical hospital of the Prelate Io-asaf is carried out. The sample of patients was organized into two groups: the first group patients to whom tradi-tional surgical interventions are applied, and entered the second - endoscopic transpapillary surgeries. Cancer of ahead of the pancreas is revealed at 177 pa-tients, cancer of a big duodenal nipple - at 145, cancer of terminal department of the general bilious channel - at 64. The duration of obstruction of bilious channels was from 3 to 45 days. The presence of obstructive jaundice at this category of patients was considered the indication to performance of endoscopic transpapillary decompres-sive interventions.he analysis of the immediate results of endo-scopic and surgical ways of treatment at this group of patients is carried out. The analysis shows the comparable level of postoperative complica-tions (r =0.096), at the same time lethality level at tra-ditional surgical interventions is indisputable above (r =0.013) (table 1, 2).Table 1. Complications and lethality in a group of patients to whom traditional surgical interventions were appliedOperation type Quantity Complications LethalityPancreatoduodenal resection 66 24 (36.3%) 4 (6%)Biliodigestive anastomosis 62 10 (16.1%) 1 (1.6%)Transduodenal papillitis resection 14 2 (14.2 %) 1 (7.1%)Other 5 2 (40%) 0In total 147 38 (25.8%) 6 (4%)Table 2. Complications and lethality in a group of patients to whom endoscopic surgical interventions were applied.Operation type Quantity Complications LethalityBiliary stenting 144 57 (38.8 %) 0Endoscopic papillitis resection 46 9 (17.7 %) 1 (2.2 %)Endoscopic suprapatellar holedochoduodenostomia 11 1 (9 %) 0In total 201 67 (33.5 %) 1 (0.5 %)We studied the remote results of the treatment of this group of patients. At the cancer of a big duodenal nipple the analysis showed the advantage of endoscopic meth-ods of treatment in comparison with traditional surgical as the big median of life expectancy - respectively is revealed 891.1 and 585 days. The main method of a decompres-sion and palliative treatment at this pathology is the en-doscopic papillitis resection through a tumor and biliary stenting which allow stopping jaundice at patients with a high degree of operational risk.  Results of surgical cancer therapy of the head of the pan-creas it is better, than in other groups (the greatest median of life expectancy -500 days- at patients after a pancreato-duodenal resection). Results of endoscopic transpapillary stenting and traditional biliodigestive anastomosis a little in what differ from each other (a life expectancy median - 225.7 and 299.0, respectively). At the same time, it should be noted that endoscopic stenting does not demand an-esthesia, it is easier transferred by patients, complications (despite their bigger percent) are controllable and easily corrections give in. The results of different types of expeditious treatment at the cancer of the general bilious channel differed from each other a little, the average life expectancy of patients did not exceed 1 year.Summary: The main method of a decompression and pal-liative treatment of patients with the periampullary can-cer complicated by obstructive jaundice are endoscopic transpapillary interventions8,9. The transduodenal papillitis resection and biliodigestive anastomosis lost the relevance now and it is necessary to resort to them only at the im-possibility of performance of radical or endoscopic inter-ventions. The carried-out statistical analysis shows the safety of endoscopic transpapillary interventions in com-parison with traditional surgical interventions at patients with periampullary cancer. In the treatment of resectable cancer of a big duodenal nipple the pancreatoduodenal resection as at this oper-ation, the best remote results are noted has to be con-sidered an operation of the choice (our observations the five-year survival was 57.5%). Comparing results of tra-ditional surgical and endoscopic methods of treatment, it is revealed that the cumulative survival more than 50% is observed in a group of patients with a pancreatodu-Materials and methodsResults and Discussion264odenal resection, more than 25% in groups of a trans-duodenal papillitis resection and endoscopic papillotomy. The remote results of palliative treatment of patients also showed the advantage of endoscopic methods of treat-ment before traditional surgical as after them authenti-cally big median of life expectancy - is observed 891.1 and 585 days, according to2,10It is impossible to call the remote results of cancer therapy of a head of a pancreas satisfactory (the greatest median of 500 days is observed in a group of patients after the performance of a pancreatoduodenal resection). Results of endoscopic transpapillary stenting and open biliodiges-tive anastomosis a little in what differ from each other, however at the same time nobiliary stenting does not demand to carry out anesthesia, is easier transferred by patients, complications (despite their bigger percent) are controllable and easily corrections give in4,5Thus, on the basis of the conducted researches it is pos-sible to conclude that at the nonresectable periampullary cancer complicated by obstructive jaundice, and also at patients of advanced and senile age with the heavy ac-companying pathology, endoscopic transpapillary inter-ventions are the main method of shunting of a biliary tree, allowing to refuse performance of traditional surgical in-terventions completely.n the treatment of patients with periampullary can-cer complicated by obstructive jaundice, methods of expeditious endoscopy are one of the priority methods of diagnostics and treatment. Endoscopic trans-papillary interventions at the present stage allow reduc-ing considerably the number of traditional surgeries that, eventually, leads to the reduction of the number of post-operative complications, lethality and improves the qual-ity of life of patients.1. Chen, Y.J. and C.L Lu, A Huge Pancreas Tumor With Periampullary Invasion. Am J Med Sci. 2018;355(6): e19.2. Hong, S., K.B Song, Y.J. Lee, K.M. Park, S.C. Kim, D.W. Hwang, J.H. Lee, S.H Shin, J. Kwon, C.H. Ma, S. Hwang, G. Park, Y. Park, S.J. Lee, and Y.W. Kim. Transduodenal pulpectomy for ampullary tumors - a single center experience of consecutive 26 patients. Ann Surg Treat Res. 2018; 95(1):22-28.3. Kagedan, D.J., J.D. Mosko, M.E. Dixon, P.J. Karanicolas, A.C. Wei, N. Goyert, Q. Li, N. Mittmann and N.G. Coburn, 2018. Changes in preoperative endoscopic and percutaneous bile drainage in patients with periampullary cancer undergoing pancreaticoduodenectomy in Ontario: effect on the clinical practice of a randomized trial. 4. Latona, J.A., S. Tannouri, T.P. Yeo, S. Cannaday, H. Lavu, J.M. Winter and C.J Yeo. Surgeon-Led Imaging Review for Patients with Periampul-lary Disease: An Important Aspect of the Preoperative Consultation. J Pancreat Cancer. 2018; 4(1):52-59.5. Matsubayashi, H., H. Ishiwatari, T. Matsui, K. Imai, K. Hotta, and H. Ono. Successful replacement of a metallic hepaticogastrostomy stent dislocated during endoscopic retrograde cholangiography. Arab J Gas-troenterol. 2018; 19(1):42-44.6. Radojkovic, M., M. Stojanovic, D. Radojkovi ć, L. Jeremic, D. Mihailovic, and I. Ilic, Histopathologic differentiation as a prognostic factor in pa-tients with carcinoma of the hepatopancreatic ampulla of Vater. J Int Med Res. 2018; 46(11):4634-4639.7. Sakai, A., M. Tsujimae, A. Masuda, T. Iemoto, S. Ashina, K. Yamakawa, T. Tanaka, S. Tanaka, Y. Yamada, R. Nakano, Y. Sato, M. Kurosawa, T. Ikegawa, S. Fujigaki, T. Kobayashi, H. Shiomi, Y. Arisaka, T. Itoh and Y. Kodama. Clinical outcomes of ampullary neoplasms in resected mar-gin positive or uncertain cases after endoscopic papillectomy. World J Gastroenterol. 2019;25(11):1387-1397.8. Sha, S.F., S. Hameed, J.K. Aurakzai, A. Raza, M.A. Chaudhry, S.H. Shah, and S.Z. Shah. Comparison Of Biliary Stenting And Surgical Bypass In Palliative Management Of Irresectable Periampullary Carcinoma. 2018; 30(1):30-33.9. Sripongpun, P., S. Attasaranya, N. Chamroonkul, T. Sookpaisal, U. Khow-Ean, A. Siripun, C. Kongkamol, T. Piratvisuth and B. Ovartlarn-porn. Simple Clinical Score to Predict 24-Week Survival Times in Pa-tients with Inoperable Malignant Distal Biliary Obstruction as a Tool for Selecting Palliative Metallic or Plastic Stents. J Gastrointest Cancer. 2018; 49(2):138-143.10. Wang, C.C., M.C. Tsai, W.W. Sung, T.W. Yang, H.Y. Chen, Y.T. Wang, C.C. Su, M.H. Tseng, and C.C. Lin. Risk of cholangiocarcinoma in pa-tients undergoing therapeutic endoscopic retrograde cholangiopan-creatography or cholecystectomy: A population-based study. World J Gastrointest Oncol. 2019;11(3):238-249.11. Zheng-Pywell, R. and S. Reddy. Ampullary cancer. Surg Clin North Am. 2019;99(2):357-367.12. Zimmer, V, 2018. Long-scope position insertion for a challenging bile duct access by a novel digital single-operator cholangioscope (Spy-Glass DS) in the periampullary diverticulum. JGH Open. 2018 Dec 12; 3(1):94-95.ConclusionsReferences

Endoscopic surgical interventions in the treatment of periampullary cancer

In this paper retrospective treatment result analysisof 386 patients with periampullary cancer, complicationsare carried out by obstructive jaundice. Patientswere organized into two groups: the first group patients towhom traditional surgical interventions were applied, andentered the second &ndash; treated with endoscopic transpapillarysurgeries. Cancer of a pancreas head is revealed in177 patients, cancer of a big duodenal nipple in 145 patientsand cancer of the terminal department of the generalbilious channel in 64 patients. The duration of biliouschannels obstruction was from 3 to 45 days. The presenceof obstructive jaundice at this category of patients wasconsidered the indication to performance of endoscopictranspapillary decompressive interventions. We haveshown that at the nonresectable cancer of bodies of apancreatoduodenal zone complicated by obstructive jaundice,endoscopic transpapillary interventions are the mainmethod of decompression of a biliary tree, thus allowingcomplete avoidance of traditional surgical interventions

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Endoscopic surgical interventions in the treatment of periampullary cancer

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