Questions of resolving cholestasis in metastatic cancer of the hepatobiliary system

Introduction: To clarify the indications for decompression of the biliary tract (BT) by proximal access and to determine the possibilities of its long-term drainage in patients with mechanical jaundice (MJ) caused by metastatic cancer of the hepatobiliary system. Methods: In the last 10 years, 178 patients were at the Scientific Center of the Liver and Biliary Diseases and the Department of Oncology and Radiology of the Tashkent Medical Academy of Metastatic Liver Cancer and in the zone of the hepatoduodenal ligament. In 69 (38.6%) of them developed MF. There were 41 women (60.1%), men - 28 (39.9%). The cause of metastatic lesion of the hepatobiliary zone was tumors of the following localization: stomach - 23 (33.3%), pancreas - 19 (27.5%), colon and rectum - 24 (35.0%), genitalia - 2 (2, 8%), lungs - 1 (1.4%). Localization, number, sizes of metastases in the liver and in the zone of the hepatoduodenal ligament, as well as the degree of dilatation of BT, the level of its obstruction was established with the help of radiation diagnostic methods: ultrasound, CT, MRI. When planning PTC, the method of 3D modeling of the biliary system, portal and caval vessels according to spiral CT and MRCP was used. Results: Favorable conditions for transhepatic drainage of BT were found in 49 (71.1%) patients, relatively favorable - in 17 (24.6%), unfavorable - in 3 (4.3%). In the last 3 cases, it was not possible to carry out PTC, the attempt to perform PTC in 4 (23.5%) observations with relatively favorable conditions was also not effective. In the nearest postoperative period, complications were present in 6 (9.6%) patients from 62 patients who managed to decompress BT by proximal access. In 2 cases, catheter prolapse occurred, and its reinstallation was performed. In 4 cases, hemobiology was noted, which was stopped conservatively. Outer internal drainage of the BT was accomplished in 5 (8.1%) cases. In the near postoperative period there were no lethal outcomes. The period of drainage of BT to 3 months was 95.1% of patients, up to 9 months - 8.0%, up to 1 year no patient survived. Conclusion: With the development of MJ in patients with metastatic cancer of the hepatobiliary system, it is necessary to find out the conditions for performing decompression of BT and, if they are available, to establish a catheter in BT proximal access. Elimination of jaundice, although not for a long time, improves the quality of life and somewhat prolongs the life of the patient.

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