Preoperative transhepatic biliary decompression in pancreatic and periampullary cancer
| Autor: | Larry C. Carey, E. Christopher Ellison, Michael E. Van Aman |
|---|---|
| Rok vydání: | 1984 |
| Předmět: |
Adult
Ampulla of Vater medicine.medical_specialty Common Bile Duct Neoplasms Pancreatectomy Postoperative Complications Preoperative Care medicine Periampullary cancer Humans Radical surgery Aged business.industry Mortality rate Cancer Cholestasis Extrahepatic Middle Aged Vascular surgery medicine.disease people.cause_of_death Surgery Cardiac surgery Pancreatic Neoplasms Cardiothoracic surgery Drainage people business Abdominal surgery |
| Zdroj: | World Journal of Surgery. 8:862-871 |
| ISSN: | 1432-2323 0364-2313 |
| DOI: | 10.1007/bf01656026 |
| Popis: | Pancreatic resection for pancreatic and periampullary cancer between 1969 and 1975 at The Ohio State University Hospitals had an associated operative mortality rate of 30% and a morbidity rate of 80%. Transhepatic biliary decompression (THD) has been accepted as a method of preoperative risk reduction in the deeply jaundiced patient and an alternative to surgical biliary decompression. The use of preoperative THD in pancreatic and periampullary cancer was examined. Of 44 patients with bilirubin greater than 10 mg/100 ml, 17 had radical resection (THD=7, no THD=10), and 27 had palliative operation (THD=17, no THD=10). Preoperative serum bilirubin in the THD group was 7.3±1.0 compared to 16.3 ±1.5 in the no THD group (p < 0.05). Operative morbidity rate was: radical surgery: THD (40%), no THD (70%); palliative surgery: THD (18%), no THD (20%). Operative mortality rate was: radical surgery: THD (28%), no THD (60%); palliative surgery: THD (6%), no THD (0%). Catheter-related complications were minimal. Preoperative THD tends to reduce the risk of curative resection for pancreatic and periampullary cancer, but does not alter the outcome of palliative surgery. Long-term THD may be an alternative if palliative surgical biliary decompression either fails or is not technically possible in the patient with unresectable cancer. |
| Databáze: | OpenAIRE |
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