Introduction: In Cameroon, surgery remains the only approach in malignant obstructions of the common bile duct (MOCBD) even in palliative situations. The aim of this work was to describe the modalities of surgical treatment of MOCBD, evaluate the results and detect the factors associated with postoperative morbidity and mortality. PatientsandMethods: We conducted an analytical observational study, with retrospective data collection from the files of patients operated upon for MOCBD. This was done in four referral hospitals in the city of Yaoundé for a 42-month period spanning from January 1, 2020 to June 30, 2023. Demographic data, clinical presentation, surgical data, and 30-day postoperative outcomes were collected. Results: We collected 71 files. The sex ratio was 1.4 and the mean age was 56 ± 11 years. Fifty-three (53) patients (74.6%) were overweight or obese and 10 patients (14.1%) were hypertensive. A clinical cholestasis syndrome was present in 69 patients (97.2%). Fifty-five (55) patients (77.5%) had a cancer of the head of the pancreas, 8 patients (11.3%) had an extra-hepatic cholangiocarcinoma and 8 patients (11.3%) had an ampullary adenocarcinoma. Eight (8) resections (11.3%) with curative intent had been carried out and in 63 cases (88.7%), surgery was palliative. Postoperative morbidity was 55.7%, influenced by advanced WHO stage (p = 0.02). Postoperative mortality was 25.7%, associated with a high ASA score (p = 0.01). Conclusion: Pancreatic head cancer is the main etiology of malignant obstructions of the common bile duct in Cameroon. Surgical treatment is most often palliative. Postoperative morbidity and mortality are high, influenced by high WHO and ASA scores.
References
[1]
Di Bisceglie, A.M., Oettle, G.J., Hodkinson, H.J., et al. (1986) Obstructive Jaundice in the South African Black Population. Journal of Clinical Gastroenterology, 8, 538-541. https://doi.org/10.1097/00004836-198610000-00009
[2]
Siddique, K., Ali, Q., Mirza, S., et al. (2008) Evaluation of the Aetiological Spectrum of Obstructive Jaundice. Journal of Ayub Medical College Abbottabad, 20, 62-66.
[3]
Gracanin, A.G., Kujundzić, M., Petrovecki, M., et al. (2013) Etiology and Epidemiology of Obstructive Jaundice in Continental Croatia. Collegium Antropologicum, 37, 131-133.
[4]
Tummala, P., Munigala, S., Eloubeidi, M.A., et al. (2013) Patients with Obstructive Jaundice and Biliary Stricture ± Mass Lesion on Imaging: Prevalence of Malignancy and Potential Role of EUS-FNA. Journal of Clinical Gastroenterology, 47, 532-537. https://doi.org/10.1097/MCG.0b013e3182745d9f
[5]
Salim, A., Jabbar, S., Amin, F.U., et al. (2018) Management and Outcome of Jaundice Secondary to Malignancies of the Gall Bladder, Biliary Tree and Pancreas: A Single Centre Experience. Journal of Ayub Medical College Abbottabad, 30, 571-575.
[6]
Rosen, J., Young, S.C., Berman, J., et al. (1989) Management of Malignant Obstructive Jaundice. Journal of Surgical Oncology, 40, 256-260. https://doi.org/10.1002/jso.2930400411
[7]
Sperti, C., Frison, L., Liessi, G., et al. (2007) The Management of Obstructive Jaundice in Pancreatic Cancer. Annali Italiani di Chirurgia, 78, 469-474.
[8]
Baron, T.H. (2006) Palliation of Malignant Obstructive Jaundice. Gastroenterology Clinics of North America, 35, 101-112. https://doi.org/10.1016/j.gtc.2006.01.001
[9]
Takongmo, S., Guifo, M.L., Pisoh Tangnyin, C., et al. (2010) Prise en charge des icteres obstructifs a yaounde. Analyse d’une serie de trente cas. Health Sciences and Diseases, 11, 1-5.
[10]
Nko’oamvene, S., Juimo, A.G. and Malonga, E.E. (1990) Icteres Obstructifs a Yaounde: Exploration Radiologique. Médecine d’Afrique Noire, 37, 783-786. https://doi.org/10.1177/019394599001200607
[11]
Bang, G.A., Moto, G.B., Ngoumfe, J.C.T., et al. (2022) What Is the Place of Surgery in the Management of Digestive Cancers in Cameroon (Central Africa)? A Study of a National Cohort of 582 Patients. Journal of Gastroenterology Research and Practice, 2, 1060.
[12]
Bang, G.A., Djopseu, L.K., Beugheum, C.C., et al. (2021) Cancers digestifs operes au cameroun: Typologie et stadification au moment du diagnostic. Health Sciences and Diseases, 22, 11-15.
[13]
Bang, G.A., Savom, E.P., Bwelle, M.G., et al. (2021) Pancreatic Head Cancer in Cameroon: Clinical Epidemiology and Survival. A Retrospective Study of 105 Cases. Surgical Chronicles, 26, 274-278.
[14]
Zou, S., Qin, R., Wang, J., et al. (2000) Prognostic Factors of Clinical Curative Effect for Malignant Obstructive Jaundice. Chinese Journal of Surgery, 38, 771-774.
[15]
Ridwelski, K., Meyer, F., Schmidt, U., et al. (2005) Results of Surgical Treatment in Ampullary and Pancreatic Carcinoma and Its Prognostic Parameters after R0-Resection. Zentralblatt fur Chirurgie, 130, 353-361.
[16]
Bao, G., Liu, H., Ma, Y., et al. (2021) The Clinical Efficacy and Safety of Different Biliary Drainages in Malignant Obstructive Jaundice Treatment. American Journal of Translational Research, 13, 7400-7405.
Kurniawan, J., Hasan, I., Gani, R.A., et al. (2016) Mortality-Related Factors in Patients with Malignant Obstructive Jaundice. Acta Medica Indonesiana, 48, 282-288.
[19]
Sharma, D., Bhansali, M. and Raina, V.K. (2002) Surgical Bypass Is Still Relevant in the Palliation of Malignant Obstructive Jaundice. Tropical Doctor, 32, 216-219. https://doi.org/10.1177/004947550203200411
[20]
Chu, D. and Adler, D.G. (2010) Malignant Biliary Tract Obstruction: Evaluation and Therapy. Journal of the National Comprehensive Cancer Network, 8, 1033-1044. https://doi.org/10.6004/jnccn.2010.0075
[21]
House, M.G. and Choti, M.A. (2005) Palliative Therapy for Pancreatic/Biliary Cancer. Surgical Clinics of North America, 85, 359-371. https://doi.org/10.1016/j.suc.2005.01.022
[22]
Wang, C.C., Yang, T.W., Sung, W.W., et al. (2020) Current Endoscopic Management of Malignant Biliary Stricture. Medicina, 56, Article No. 114. https://doi.org/10.3390/medicina56030114
[23]
Popiela, T., Kedra, B., Sierzega, M. and Kubisz, A. (2002) Surgical Palliation for Pancreatic Cancer. The 25-Year Experience of a Single Reference Centre. Zentralblatt fur Chirurgie, 127, 965-970. https://doi.org/10.1055/s-2002-35760
[24]
Al-Fallouji, M.A. and Collins, R.E. (1985) Surgical Relief of Obstructive Jaundice in a District General Hospital. Journal of the Royal Society of Medicine, 78, 211-216. https://doi.org/10.1177/014107688507800308
[25]
Han, X.C., Li, J.L. and Han, G. (2003) Surgical Mortality in Patients with Malignant Obstructive Jaundice: A Multivariate Discriminant Analysis. Hepatobiliary & Pancreatic Diseases International, 2, 435-440.
