Expanding indications for laparoscopic parenchyma-sparing resection of posterosuperior liver segments in patients with colorectal metastases: comparison with open hepatectomy for immediate and long-term outcomes.

BACKGROUND: Laparoscopic liver resection (LLR) of posterosuperior segments (PSS) is still technically demanding procedure for highly selective patients. There is no long-term survival comparative estimation after LLR and open liver resection (OLR) for colorectal liver metastases (CRLM) located in PSS. We aimed to compare long-term overall (OS) and disease-free survival (DFS) after parenchyma-sparing LLR with expanding indications and open liver resection (OLR) of liver PSS in patients with CRLM. METHODS: Two Russian centers took part in the study. Patients with missing data, hemihepatectomy and extrahepatic tumors were excluded. One of contraindications for LLR was suspicion for tumor invasion in large hepatic vessels. Logistic regression was used for 1:1 propensity score matching (PSM). RESULTS: PSS were resected in 77 patients, which accounted for 42% of the total number of liver resections for CRLM. LLR were performed in 51 (66%) patients. Before and after matching, no differences were found between groups in the following factors: median size of the largest metastatic tumor; proximity to the large liver vessels; the rate of anatomical parenchyma sparing resection of PSS; a positive response to chemotherapy before and after surgery. Regardless of matching, the size of the largest metastases was above 50 mm in more than one-third of patients who received LLR. Before matching, intraoperative blood loss, ICU stay and hospital stay were significantly greater in the group of OLR. No 90-day mortality was observed within both groups. There were no differences in long-term oncological outcomes: 5-year OS after PSM was 78% and 63% after LLR and OLR, respectively; 4-year DFS after PSM was 27% in both groups. CONCLUSION: Laparoscopic parenchyma-sparing resection of PSS for CRLM are justified in majority of patients who have an indication for OLR if performed in high volume specialized centers expertized in laparoscopic liver surgery.

[Postoperative ventral hernia in patients, who undergone the liver transplantation operation].

The development of postoperative ventral hernia was observed in 8 patients from 114, who undergone the liver transplantation operation. The patients were followed in terms up to 14.5 years. The authors consider the indications and features of surgical treatment of such postoperative hernias.

[An experience with 100 cadaveric transplantations of the liver in the Russian Research Center of Radiology and Surgical Technologies].

The authors made an analysis of their first 100 transplantations of cadaveric liver made at the period from 1998 through 2011. Postoperative complications and long-term results of transplantations at the period to 13 years are described. Cumulative survival up to 12 months was 91%, to 36 months--83%. Retransplantation of the liver was performed on 5 patients, 2 of them being successful.

[Treatment of hepatic malignancies with implantation of a venous port into the portal vein].

The report deals with venous port implantion into the portal vein to conduct both single and continuous courses of regional chemotherapy without recourse to repeat puncture and catheterization of the vein to avoid hemorrhagic complications and arterioportal fistula. Application of repeat courses of intraportal chemotherapy might make use of ultrasound and X-ray equipment to monitor the catheter position in portal vein lumen as well as unauthorized drug consumption unnecessary. Catheterization of the portal vein across the adjacent edge of the liver seals the punctured hole reliably with a U-shaped suture which prevents bleeding into the abdomen and secures the catheter in place.

[Methods of correcting hepatic arterial blood supply for subsequent implantation of the "port-catheter" infusion system].

The study was undertaken to investigate the feasibility of using surgical and roentgenoendovascular redistribution of the hepatic arterial blood flow for adequate implantation of the "port-catheter" infusion system. Between December 2001 and March 2008, we performed surgical (n = 25) or transcutaneous (n = 22) implantations of the infusion systems for carrying out regional chemotherapy in a total of forty-seven patients presenting with hepatic metastases of colorectal carcinoma. Anatomical variants of the hepatic arteries were observed in eleven cases. The blood stream was corrected by means of either transcatheter embolization (n = 7), ligation (n = 2), or transposition (n = 2) of the aberrant arteries. No complications were encountered. In all the cases, the "port-catheter" system was implanted successfully, with adequate hepatic perfusion achieved. Both transcatheter embolization and surgical reconstruction turned out to be efficient methods in correction of the blood flow in various anatomical structures of the hepatic arteries, thus favourably contributing to increased efficacy of regional chemotherapy.

[The role of vascular reconstructions in the surgery of tumors of the hepatopancreatobiliary zone].

An analysis of results of 83 operations performed for tumors of the hepatopancreatobiliary zone included the period of 2006-2007. In 39 resections of the pancreas there were 16 (41.0%) cases when the operation was supplemented with a reconstruction of the major vessels. From 44 resections of the liver 10 (22.7%) interventions were made with resection of the major veins. No specific complications were noted associated with vascular reconstructions in the zones in question. Postoperative lethality after operations for malignant tumors of the hepatopancreatobiliary zone was 2.4%, after operations in the same zone supplemented with vascular reconstructions was 3.8%. The duration of postoperative hospital stay was practically the same of that of the patients operated for malignant tumors of the hepatopancreatobiliary zone without vascular reconstructions. One year survival of the patients operated for malignant tumors of the hepatopancreatobiliary zone without and with vascular reconstructions was commensurable. Reconstruction of the major vessels in operations for locally extensive tumors of the hepatopancreatobiliary zone allows more often using radical surgical interventions. Complete restoration of the patency of the major vessels in the zone of operations for tumor processes in the liver and pancreas alleviates the postoperative period, is not followed by more number of postoperative complications and lethality.

[Cytoreductive surgery with placement of intra-arterial infusion pump for unresectable liver tumors].

The initial results are discussed of treatment protocol for unresectable liver tumors using combinations of cytoreductive surgery (resection and/or radiofrequency ablation (RFA)) and hepatic artery infusion pump (HAIP) placement to be followed by chemotherapy. Out of 14 patients with unresectable liver tumors (2003-2006), 12 were operated on for colorectal metastases, 1 - hepatocellular carcinoma, and 1 metastatic carcinoid. Seven patients received RFA, 4 - resection+RFA+ HAIP, and 3 - resection+ HAIP. All patients were given HAIP postoperatively. No grave complications were reported. Mean follow-up was 14 months (6-38) with an average of 6 chemotherapy cycles (2-12) per patient. At present, 8 patients have survived 6-38 months and continue to receive regional chemotherapy; overall 1- or 2- year survival is 85 and 57%, respectively. Six patients died from tumor progression within 4-21 months.

[Intraarterial chemotherapy using implantable port-catheter system in patients with colorectal liver metastases].

We evaluated the tentative clinical results of port-catheter system implantation in 32 patients (18 males and 14 females) with liver metastases of colorectal cancer (2001-2006). Laparotomic approach was used in 17 and percutaneous transfemoral implantation - in 15 patients. There were no complications nor technical problems. All patients received a total of 160 cycles of infusion chemotherapy, ranging 2-11 (4 on the average); mean follow-up - 241 (57-730) days . At present, 21 patients have survived for 5-28 months. Three of them (14%) report complete response, 13 (62%) - stabilization and 5 (24%) - tumor progression. One-year survival in all patients was in 76.5%. Eleven patients died through tumor progression unrelated to the liver.