Креативная хирургия и онкология (Jan 2023)
Risk prediction program for choosing methods of biliary tract decompression in patients with obstructive jaundice caused by tumors: clinical testing
Abstract
Introduction. The most pressing problems in abdominal oncology surgery are the development of obstructive jaundice as a complication in patients with malignant tumors in the hepatobiliary and pancreatoduodenal area, and the ways to eliminate it and to reduce the risk of adverse events. Our earlier research revealed 14 predictors that together are more likely to cause undesirable postoperative complications, including deaths during minimally invasive biliary tract decompression. On the basis of the data obtained, a computer program “Risk Assessment of Treatment Methods for Obstructive Jaundice” was created.Materials and methods. The program was introduced into clinical practice in Yaroslavl Regional Clinical Oncology Hospital and was tested on 144 patients from 2019 through 2022. Th e program issued a conclusion on the risk of adverse events and assigned the patient to one of the groups where drainage or stenting were recommended for the first stage of biliary tract decompression.Results and discussion. Following a collegial decision based on the results obtained via the program, 58 patients (40.28 %) underwent endoscopic stenting and 86 patients (59.72 %) underwent percutaneous transhepatic biliary drainage. In the study group, adverse events developed in 10 patients (6.94 %), while in the control group — in 50 patients (22.94 %), and 134 patients (93.06 %) had no complications, as compared to 168 patients (77.06 %) in the control group.Conclusion. Application of the program based on reliable and practically significant 14 predictors results in a decline in general complications induced by minimally invasive biliary tract decompression from 22.94 % to 6.94 % and a 3.5-fold decrease in mortality from 5.05 % to 1.39 % in patients with malignant neoplasms in the hepatobiliary and pancreatoduodenal area, complicated by obstructive and mixed jaundice.
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