The experience of using indocyanine and low-frequency piezothromboelastography to assess liver failure in a patient with a tumor of the periampular zone complicated by obstructive jaundice

Pancreaticoduodenal resection is the only radical surgical method for the treatment of patients with malignant periampullary tumors. Mechanical jaundice in most cases is the first manifestation of the disease. Patients in this category are often emaciated, have impaired liver function and are at high risk of perioperative complications. One of the ways to solve this issue is preoperative drainage of biliary tract. At the same time, there are contradictory views on the optimal timing of radial surgery after biliary drainage. In this article we present our experience of using additional methods to assess liver function in a patient with mechanical jaundice, which allow us to optimize the treatment strategy. A 71-year-old patient diagnosed with adenocarcinoma of the large duodenal papilla complicated by intestinal bleeding and mechanical jaundice. Selective embolization of a. gastroduodenalis branches and percutaneous transhepatic biliary drainage were performed at the first stage. In the postoperative period active infusion and detoxification therapy was continued. On the 10th day the functional state of the liver and hemostasis system was evaluated using low-frequency piezothromboelatostography and evaluation of indocyanine green elimination: structural and chronometric hypocoagulation were eliminated, plasma elimination rate increased 5 times. On the 11th day the patient underwent pancreaticoduodenal resection, the postoperative period proceeded against the background of biochemical fistula formation. Thus, evaluation of indocyanine green elimination and low-frequency piezothromboelastography can be used in complex assessment of the patient’s condition when choosing the tactics of surgical treatment of patients with pancreaticoduodenal tumors complicated by mechanical jaundice.

obstructive jaundice, indocyanine green, periampular tumor, pancreatoduodenal resection, low-frequency piezothromboelastography

1. Blacker S., Lahiri R.P., Phillips M. et al. Which patients benefit from preoperative biliary drainage in resectable pancreatic cancer? Expert Rev Gastroenterol Hepatol. 2021 Aug;15(8):855-863. doi: 10.1080/17474124.2021.1915127.

2. Sementsov K., Tyagun M., Kruglov E. et al. Algorithm for nutritional support of patients pancreatoduodenectomy. Medline.ru. 2014; 15: 639-648. (in Russ.) Available at: http://www.medline.ru/public/art/tom15/art51.html (Accessed: 05.05.2024.)@@ Семенцов К.В., Тягун М.Н., Круглов Е.А. и др. Алгоритм нутритивной поддержки больных после панкреатодуоденальной резекции. Medline.ru. 2014; 15: 639-648 [http://www.medline.ru/public/art/tom15/art51.html

3. Khatkov I.E., Tsvirkun V.V., Izrailov R.E. et al. Laparoscopic Pancreatoduodenectomy: Results Evolution over 215 Procedures. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2018;23(1):47-54. (In Russ.) doi: 10.16931/1995-5464.2018-1-47-54.@@ Хатьков И.Е., Цвиркун В.В. Израилов Р.Е., и др. Лапароскопическая панкреатодуоденальная резекция: эволюция результатов 215 операций. Анналы хирургической гепатологии. 2018; 23(1):47-54. doi: 10.16931/1995-5464.2018-1-47-54.

4. Crippa S., Cirocchi R., Partelli S. et al. Systematic review and meta-analysis of metal versus plastic stents for preoperative biliary drainage in resectable periampullary or pancreatic head tumors. Eur J Surg Oncol. 2016 Sep;42(9):1278-85. doi: 10.1016/j.ejso.2016.05.001.

5. Allemani C., Matsuda T., Di Carlo V. et al.; CONCORD Working Group. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018 Mar 17;391(10125):1023-1075. doi: 10.1016/S0140-6736(17)33326-3.

6. Siegel R.L., Miller K.D., Fuchs H.E., Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021 Jan;71(1):7-33. doi: 10.3322/caac.21654.

7. Kaprina A.D., Starinsky V.V., Shakhzadova A.O. [Malignant neoplasms in russia in 2021 (Morbidity and mortality)]. P.A. Herzen Moscow Oncology Research Institute - branch of the National Medical Research Center of Radiology of the Ministry of Health of the Russian Federation. Moscow. 2022. 252 p. (in Russ.)@@ Каприна АД, Старинский ВВ, Шахзадова АО. Злокачественные новообразования в россии в 2021 году (заболеваемость и смертность). МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИЦ радиологии» Минздрава России. Москва; 2022. 252 с.

8. Gholami S., Brennan M.F. Preoperative Stenting for Benign and Malignant Periampullary Diseases: Unnecessary if Not Harmful. Surg Clin North Am. 2018 Feb;98(1):37-47. doi: 10.1016/j.suc.2017.09.005.

9. Galperin E.I., Akhaladze G.G., Vetshev P.S., Dyuzheva T.G. Differentiated approach to the minimally invasive management of malignant obstructive jaundice. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2019;24(2):10-24. (In Russ.) doi: 10.16931/1995-5464.2019210-24.@@ Гальперин Э.И., Ахаладзе Г.Г., Ветшев П.С., Дюжева Т.Г. Дифференцированный подход к применению минимально инвазивных методов лечения опухолевой механической желтухи. Анналы хирургической гепатологии - 2019. -№ 24(2) - С. 10-24. doi: 10.16931/1995-5464.2019210-24.

10. Gao Z., Wang J., Shen S., Bo X., Suo T., Ni X., Liu H., Huang L., Liu H. The impact of preoperative biliary drainage on postoperative outcomes in patients with malignant obstructive jaundice: a retrospective analysis of 290 consecutive cases at a single medical center. World J Surg Oncol. 2022 Jan 6;20(1):7. doi: 10.1186/s12957-021-02476-z.

11. Iacono C., Ruzzenente A., Campagnaro T., Bortolasi L., Valdegamberi A., Guglielmi A. Role of preoperative biliary drainage in jaundiced patients who are candidates for pancreatoduodenectomy or hepatic resection: highlights and drawbacks. Ann Surg. 2013 Feb;257(2):191-204. doi: 10.1097/SLA.0b013e31826f4b0e.

12. Semenov K.V., Boyarinov D. Yu., Myanzelin M.N., Alekseev V.V., Koshelev T.E., Goloshchapova I.M. Tumors of the periampullary zone complicated by mechanical jaundice - where to start, drainage or resection (scientific review). Preventive and Clinical Medicine. 2022;1 (82):26-32. (in Russ.) doi: 10.47843/2074-9120_2022_1_26.@@ Семенцов К.В., Бояринов Д.Ю., Мянзелин М.Н., Алексеев В.В., Кошелев Т.Е., Голощапова И.М. Опухоли периампулярной зоны, осложненные механической желтухой - с чего начать, дренирование или резекция (научный обзор). Профилактическая и клиническая медицина. - 2022. - № 1 (82). - С. 26-32. doi: 10.47843/2074-9120_2022_1_26.

13. Sharon C.E., Thaler A.S., Straker R.J. 3rd. et al. Fourteen years of pancreatic surgery for malignancy among ACS-NSQIP centers: Trends in major morbidity and mortality. Surgery. 2022 Aug;172(2):708-714. doi: 10.1016/j.surg.2022.03.030.

14. Nehme F., Lee J.H. Preoperative biliary drainage for pancreatic cancer. Dig Endosc. 2022 Mar;34(3):428-438. doi: 10.1111/den.14081.

15. Garcea G., Chee W., Ong S.L., Maddern G.J. Preoperative biliary drainage for distal obstruction: the case against revisited. Pancreas. 2010 Mar;39(2):119-26. doi: 10.1097/MPA.0b013e3181bd65de.

16. Changazi S.H., Ahmed Q., Bhatti S., Siddique S., Abdul Raffay E., Farooka M.W., Ayyaz M. Whipple Procedure: A Five-Year Clinical Experience in Tertiary Care Center. Cureus. 2020 Nov 13;12(11): e11466. doi: 10.7759/cureus.11466.

17. Irrinki S., Kurdia K., Poudel H. et al. “Impact of Preoperative Biliary Drainage in Patients Undergoing Pancreaticoduodenectomy” - a Prospective Comparative Study from a Tertiary Care Centre in India. Indian J Surg Oncol. 2022 Sep;13(3):574-579. doi: 10.1007/s13193-022-01528-4.

18. Vendemiale G., Grattagliano I., Lupo L., Memeo V., Altomare E. Hepatic oxidative alterations in patients with extra-hepatic cholestasis. Effect of surgical drainage. J Hepatol. 2002 Nov;37(5):601-5. doi: 10.1016/s0168-8278(02)00234-9.

19. Gulman M.I., Vinnik Yu. S., Pakhomova R.A. et al. [Actual problems of liver failure in mechanical jaundice: diagnostics (report 1)]. Baikal Medical Journal. 2012. 110 (3), 22-27. (in Russ.)@@ Гульман М.И., Винник Ю.С., Пахомова Р.А. и др. Актуальные проблемы печеночной недостаточности при механической желтухе: диагностика (сообщение 1). Байкальский медицинский журнал. 2012. 110 (3), 22-27.

20. Kloek J.J., Heger M., van der Gaag N.A., Beuers U., van Gulik T.M., Gouma D.J., Levi M. Effect of preoperative biliary drainage on coagulation and fibrinolysis in severe obstructive cholestasis. J Clin Gastroenterol. 2010 Oct;44(9):646-52. doi: 10.1097/MCG.0b013e3181ce5b36.

21. Shabunin A.V., Tavobilov M.M. [Choice of the method of bile duct decompression in the treatment of patients with mechanical jaundice of tumor genesis].Russian Medical and Biological Bulletin named after Academician I.P. Pavlov. 2016;(1):68-74. (in Russ.)@@ Шабунин А.В., Тавобилов М.М. Выбор способа декомпрессии желчных протоков в лечении больных механической желтухой опухолевого генеза. Российский медико-биологический вестник имени академика И.П. Павлова. 2016;(1):68-74.

22. Matsumoto M., Nakabayashi Y., Fujiwara Y. et al. Duration of Preoperative Biliary Drainage as a Prognostic Factor After Pancreaticoduodenectomy for Pancreatic Head Cancer. Anticancer Res. 2017 Jun;37(6):3215-3219. doi: 10.21873/anticanres.11683.

23. Ozgun Y.M., Colakoglu M.K., Oter V. et al. Biliary Stenting Prior to Pancreaticoduodenectomy and its Effects on Postoperative Outcome. Twenty Years of Experience with 805 Patients. Arch Iran Med. 2021 Oct 1;24(10):771-778. doi: 10.34172/aim.2021.114.

24. Park B.K., Jeon T.J., Jayaraman V., Hammerle C., Gupta K., Jamil L.H., Lo S.K. Endoscopic Retrograde Cholangiopancreatography in Patients with Previous Pancreaticoduodenectomy: A Single-Center Experience. Dig Dis Sci. 2016 Jan;61(1):293-302. doi: 10.1007/s10620-015-3861-z.

25. Li Z., Zhang Z., Hu W. et al. Pancreaticoduodenectomy with preoperative obstructive jaundice: drainage or not. Pancreas. 2009 May;38(4):379-86. doi: 10.1097/MPA.0b013e31819f638b.

26. Shin S.H., Han I.W., Ryu Y., Kim N., Choi D.W., Heo J.S. Optimal timing of pancreaticoduodenectomy following preoperative biliary drainage considering major morbidity and postoperative survival. J Hepatobiliary Pancreat Sci. 2019 Oct;26(10):449-458. doi: 10.1002/jhbp.652.

27. Bhatti A.B.H., Jafri R.Z., Khan M.K., Dar F.S. Preoperative Endoscopic Biliary Stenting Before Pancreaticoduodenectomy: Does Timing Matter? Surg Innov. 2021 Oct;28(5):567-572. doi: 10.1177/1553350620975887.

28. Wang D, Lin H, Guan C, et al. Impact of preoperative biliary drainage on postoperative complications and prognosis after pancreaticoduodenectomy: A single-center retrospective cohort study. Front Oncol. 2022; 12:1037671. Published 2022 Nov 10. doi:10.3389/fonc.2022.1037671.