"SIMULTANEOUS BILIO- AND GASTROENTEROSTOMY AS THE PALLIATIVE TREATMENT OF PATIENTS WITH ADVANCED CANCER OF PANCREATIC HEAD" - original clinical research. Author (Shamrai Dmitriy) has reported this research in Novi Sad, Serbia (IMSCNS 2014 - International Medical Students' Congress in Novi Sad). My contacts: shamraydv@gmail.com, www.facebook.com/dmitriy.shamrai, http://vk.com/armata_manus.

1. Bolomolets National Medical University
(Kiev, Ukraine)
Surgery department # 2
SIMULTANEOUS BILIO- AND
GASTROENTEROSTOMY AS THE PALLIATIVE
TREATMENT OF PATIENTS WITH ADVANCED
CANCER OF PANCREATIC HEAD
Supervisor: prof. Bezrodny B.G.
Shamrai Dmytriy
Novi Sad 17-20.07.2014

2. * http://seer.cancer.gov

4. Mayor problems in advanced
pancreatic cancer
1. Obstructive jaundice (70%
cases – head localization of
cancer)
2. Gastric outlet obstruction
(8-17% cases)
3. Pain
Surgical by-pass (SBP) or
endoscopic stenting
Surgical by-pass (SBP)
Chemical
splanchnice
ctomy
OR
Simultaneous bilio- and gastroenterostomy

5. The Aim
• To evaluate the effectiveness and
practicability of simultaneous bilio- and
gastroenteral bypass as the palliative
treatment of patients with advanced cancer of
pancreatic head complicated by obstructive
jaundice;
• To improve quality of life of patients with
advanced pancreatic cancer.

6. Materials and Methods
→ tumor histologically identified as adenocarcinoma
→ complicated by obstructive jaundice
→ average age of patients 65.3±1.7 years

7. Materials and Methods
I group - 33 patients II group - 27 patients
cholecystoenterostomy
with isolated loop by
Brown-Shalimov
simultaneous retrocolic
hepaticoenterostomy with
isolated Roux-en-Y loop
and gastroenterostomy

8. Particularities of our method
*Patent UA 71046 U (Bezrodny, Kolosovich, Filatov, Shamrai), 25/06/2012.

9. Results
I group (33 patients) II group (27 patients)
1. Total hospital stay, days 7,1 ± 0,7 7,5 ± 0,6
2. Operation duration, min 110 ± 8 184 ± 15
3. Use of analgesics, days NSAID 4.1 ± 0.3 NSAID 4.18 ± 0.4
4. Complications 6 cases (18%) - duodenal
obstruction in 5,5 ± 0.2
months
1 case (3.7%) –
bilioenteral anastomotic
leak
5. Reoperation rates 6 cases (18%) no
6. Life duration, months 8,2 ± 0,4 9,4 ± 0,3

10. Operation duration
110
184
Operation duration, min
Group I
(cholecystoenterostomy)
Group II
(hepaticoenterostomy
and
gastroenterostomy)

11. Reoperation rates

12. • Technique of simultaneous bilio- and
gastroenterostomy reduces reoperation rates,
improves quality of life, increases the patient’s
lifespan;
• Simultaneous bilio- and gastroenterostomy is
recommend in advanced pancreatic cancer
patients, when expectancy of life is more then
6 months;

13. • Hepaticoenteroanastomosis fixation to lig.
teres hepatis helps to avoid tension and
anastomotic leak;
• Additional gastroenteroanastomosis doesn’t
increase morbidity and mortality rates.

15. Stents vs SBP
Conclusion: “Endoscopic metal stents are the
intervention of choice at present in patients
with malignant distal obstructive jaundice due
to pancreatic carcinoma. In patients with short
predicted survival, their patency benefits over
plastic stents may not be realised.”
* Moss AC et all “Palliative biliary stents for obstructing
pancreatic carcinoma” (Cochrane Review)”

16. Locally Advanced Pancreatic Head Cancer:
Margin-Positive Resection or Bypass?
• “R1 resections had a significantly better
survival than the BYP-M0 group (median 18
months, 3-year survival 8%)”;
• “R1+portal venous resection= median 19
months, 3-year survival 15%”.
*Ulrich Friedrich Wellner et all., ISRN Surgery, 2012