THE PA LLIATIVE TREATMENTS OF OBSTRUCTIVE JOUNDICE IN PERIVATERIAN TUMOURS.

Abstract

Objective. The evaluation of the palliative procedures, surgical and endoscopical or radiological, in the treatment of patients affected by obstructive jaundice resulting from periampullary tumors.

Subjects Patients with jaundice by periampullary tumors undergoing to surgery or to endoscopical or radiological procedures from january 1987 to april 1998.

Results Jaundice has come down in all patients after surgery. Mortality after surgery was 5.2% (5.9% in geriatric patients); morbility 15.8% (17.6% in geriatric patients) survival 10.4 months after surgery (8.8 months in geriatric patients) versus 3.1 months after non surgical procedures.

Discussion In all patients periampullary tumors are more frequent than hepatic hilum and common bile duct tumors. We have performed surgical and not surgical palliative procedures more frequently than curative resection (DCP), especially in geriatric patients (94.5% versus 79%). In geriatric patients we have chosen, between bile-digestive by-passes, the cholecystojejunal anastomosis because it is easier and faster to carry out than choledoch-jejunal anastomosis with the same results as well as from literature data. We have always performed a gastroentero anastomosis in association with palliative surgical procedures to prevent or to solve a duodenal obstruction. This additional treatment didn’t show an increasing of mortality and morbility as well as from literature data.

Conclusions. We have reserved the palliative non surgical procedures only to high surgical risk patients. In the other cases we have chosen palliative surgery for better long-term results and quality of life in the general series patients as well as in geriatric patients.