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

Comparative analysis of the results of traditional and endoscopic surgical palliative treatment of pancreatoduodenal cancer is given in the article. Intervention of X-ray-endobiliary operations in the treatment of such patients changes the surgical tactics. It has been shown that traditional methods of biliarydygestive anastomosis cause the higher rate of complications and mortality in the early postoperative period in comparison with endoscopic transpapillary operations. Stenting also has been proved to be safe and effi cient kind of shunting of biliary tree that improves the quality of patient’s life. Miniinvasive???ness and preservation of natural bile outfl ow into the duodenum and low rate of complications are the main advantages of endoshunting

В работе проведен анализ непосредственных результатов эндоскопических методов паллиативного хирургического лечения рака панкреатодуоденальной зоны. Доказано, что при раке дистального отдела холедоха и головки поджелудочной железы стентирование является относительно безопасным и эффективным видом шунтирования билиарного дерева, улучшающим качество жизни пациентов. Преимуществом эндопротезирования является малоинвазивность, сохранение естественного оттока желчи в дуоденальный канал и небольшой процент осложнений. Основным методом паллиативного лечения рака БСДК является папиллотомия через опухоль, позволяющая купировать явления желтухи у больных с высокой степенью операционного риска.

93 patients with chronic pancreatitis were treated endoscopically: 44 had transpapillar procedures and 49 patients had transmural operations. The transmural procedures were applied in case of pancreatic pseudicysts, whereas transpapillar endoscopic operations were applied in cases of the obstructive jaundice, pseudocyst, connected of the main pancreatic duct, virsungolithyasis or ductal pancreatitis with pain syndrome. The endoscopic procedures by chronic pancreatitis proved to be the reliable alternative to the traditional surgery.

Authors' experience in treating 142 patients aged 32 to 94 suffered from cancer of the major duodenal papilla allows to substantiate indications and contraindications for various types of surgeries. The authors consider the gastropancreatoduodenal resection to be feasible in small number of observations; it often appears to be impossible in respect of elderly patients due to associated serious pathology. The preference should be given to endoscopic methods of treatment that allow to arrest obstructive jaundice. These methods can be both separate palliative and staged surgical procedures to be performed prior to radical surgery.