COMPARATIVE EVALUATION OF THE RESULTS OF TRADITIONAL AND ENDOSCOPIC METHODS OF SURGICAL TREATMENT OF THE LARGE DUODENAL PAPILLA CANCER
Aim. To assess the immediate and long-term results of conventional and endoscopic surgical treatment of the large duodenal papilla cancer. Methods. Performed was a retrospective analysis of the results of conventional and endoscopic treatment methods in 145 patients with cancer of the large duodenal papilla. Gastric-pancreatic-duodenal resection was performed in 35 patients, transduodenal papillectomy - in 14 patients, palliative surgery, aimed at creating a biliary-enteric bypass anastomosis - in 19 patients, endoscopic stenting through the tumor - in 20 patients, endoscopic supra-papillary choledochoduodenostomy - in 11 patients, endoscopic papillotomy through the tumor -in 46 patients. In order to evaluate the long-term results we used the Kaplan - Meier method of multipliers estimates. Results. The five-year survival rate after radical surgery was 57.5%. Comparison of the results of traditional and endoscopic methods of treatment showed that the cumulative survival rate of more than 50% was observed in a group of radical surgery, more than 25% - after transduodenal papillectomy and endoscopic papillotomy. The highest median survival (891 days) was observed in patients after stenting. Conclusions. In the diagnosis of cancer of the large duodenal papilla the prerequisite condition is the conduction of a complete endoscopic papillotomy. In the treatment of resectable cancer gastric-pancreatic-duodenal resection should be the operation of choice, because after this operation there were better long term outcomes. The immediate results of palliative traditional and endoscopic interventions have shown the advantage of endoscopic methods of decompression. Long-term outcomes of palliative treatment of patients were better than such of endoscopic treatment, since a larger median life expectancy was observed after those procedures. The main methods of decompression and palliative treatment of cancer of the large duodenal papilla are endoscopic papillotomy through the tumor and stenting