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.

Percutaneous radiofrequency-assisted liver partition versus portal vein embolization before hepatectomy for perihilar cholangiocarcinoma.

BACKGROUND: Percutaneous radiofrequency-assisted liver partition with portal vein embolization in staged liver resection (PRALPPS) represents an alternative to portal vein embolization (PVE) followed by major liver resection in patients with perihilar cholangiocarcinoma. METHODS: This was an observational case-control study. Both procedures were applied in patients with a future liver remnant (FLR) volume of less than 40 per cent. The main end points of the study were short-term morbidity and mortality for the two procedures. The study also compared the efficacy of the preresection phases estimated by kinetic growth rate (KGR), time interval and degree of hypertrophy of the FLR. RESULTS: The first phase (preresection) was completed in 11 and 18 patients, and the second phase (resection) in nine and 14 patients, in the PRALPPS and PVE groups respectively. Major morbidity after the first stage did not differ between the groups. There were no differences in blood loss, severe morbidity or liver failure rate after the second stage, with no deaths. The mean KGR of the FLR after the preresection phase for PRALPPS was 3·8 (0·6-9·8) per cent/day, and that after PVE was 1·8 (0-6·7) per cent/day (P = 0·037). The mean time interval for FLR hypertrophy in the PRALPPS and PVE groups was 15 (6-29) and 20 (8-35) days respectively (P = 0·039). CONCLUSION: Short-term outcomes were similar for PRALPPS and PVE in terms of safety. Remnant hypertrophy was achieved more rapidly by PRALPPS.

ANTECEDENTES: La partición hepática asistida por radiofrecuencia percutánea con embolización de la vena porta en la resección hepática en varios tiempos quirúrgicos (percutaneous radio-frequency assisted liver partition with portal vein embolization in staged liver resection, PRALPPS) representa una alternativa a la embolización de la vena porta seguida de resección hepática mayor (portal vein embolization, PVE) en pacientes con colangiocarcinoma perihiliar (perihiliar cholangiocarcioma, PHCC). MÉTODOS: Se trata de un estudio observacional de casos y controles. Se efectuaron ambos procedimientos en pacientes con un volumen hepático remanente futuro (future liver remnant, FLR) < 40%. Los resultados principales del estudio fueron la morbilidad a corto plazo y la mortalidad de ambos procedimientos. En el estudio también se comparó la eficacia de las fases de pre-resección mediante la tasa cinética de crecimiento (kinetic growth rate, KGR), el intervalo de tiempo y el grado de hipertrofia del FLR. RESULTADOS: Se completaron la primera (pre-resección) y la segunda (resección) fase en 11/9 y 18/14 pacientes en los grupos PRALPPS y PVE, respectivamente. La morbilidad mayor tras el primer tiempo no difirió entre los grupos. No se observaron diferencias en la pérdida de sangre, morbilidad grave y tasa de insuficiencia hepática tras el segundo tiempo, sin que ocurriera ningún fallecimiento. La media de KGR del FLR tras la fase de pre-resección fue de 3,8 (0,6-9,8) %/día en el grupo PRALPPS y de 1,8 (0-6,7) %/día tras PVE (P = 0,037). La media de intervalo de tiempo de la hipertrofia del FLR en los grupos PRALPPS y PVE fue de 15 (6-29) días y 20 (8-35) días, respectivamente (P = 0,039). CONCLUSIÓN: Los resultados a corto plazo fueron similares en términos de seguridad. La hipertrofia del hígado remanente se alcanzó más rápidamente con la PRALPPS.

[Early outcomes of robot-assisted liver resection]. / Robot-assistirovannye rezektsii pecheni. Otsenka blizhaishikh rezul'tatov.

AIM: To assess an experience of robot-assisted liver resection using CUSUM-test. MATERIAL AND METHODS: The results of 46 robot-assisted liver resections were retrospectively analyzed by using of CUSUM-test. RESULTS: There were 3 periods in development of the technology. The 1st period - procedures with the lowest index of difficulty (n=16), the 2nd period - expansion of the indications for difficult resections (n=18) and the 3rd period - stabilization of the results (n=12). The dynamics of difficulty index, intraoperative blood loss, duration of procedure and morbidity (Clavien-Dindo Grade II-V) were evaluated. Five liver resections were needed to decrease blood loss and duration of the procedure. Expansion of indications was feasible after 16 procedures. Stable results were obtained after 34 liver resections.

[Intrahepatic cholangiocarcinoma followed by vascular invasion: is surgical treatment justified?] / Vnutripechenochnaia kholangiokartsinoma s invaziei v sosudy: opravdano li khirurgicheskoe lechenie?

Intrahepatic cholangiocarcinoma (ICC) is one of the most aggressive tumors associated with poor prognosis. Radical surgery is still the main method of treatment in resectable cases. Certain difficulties are observed in case of locally advanced tumors followed by inferior vena cava (IVC) and portal vein (PV) invasion. AIM: To analyze safety of advanced liver resections combined with great vessels repair for locally advanced large and multiple cholangiocellular carcinoma. MATERIAL AND METHODS: Since January 2014 till April 2017 eighty ICC patients have undergone advanced liver resection. There were 62 patients with portal cholangiocarcinoma and 18 with ICC. 4 ICC patients required vascular repair: IVC replacement in 2 cases (i.e. under venous bypass in 1 of them), tangential and circular resection of portal vein bifurcation - in 2 cases. RESULTS: Postoperative complications Clavien-Dindo IIIa developed in all cases. There were no vascular complications. The length of hospital-stay was 14 - 35 days. There were no lethal outcomes. Annual survival was 50%, 2-year - 25%. Adjuvant chemotherapy was used in all patients. CONCLUSION: Advanced liver resection followed by IVC and PV repair for locally advanced ICC may be safely performed and subsequently allows chemotherapeutic treatment.

Pancreas-preserving approach to "paraduodenal pancreatitis" treatment: why, when, and how? Experience of treatment of 62 patients with duodenal dystrophy.

BACKGROUND: The term "paraduodenal pancreatitis" (PP) was proposed as a synonym for duodenal dystrophy (DD) and groove pancreatitis, but it is still unclear what organ PP originates from and how to treat it properly. OBJECTIVE: To assess the results of different types of treatment for PP. METHOD: Prospective analysis of 62 cases of PP (2004-2013) with histopathology of 40 specimens was performed; clinical presentation was assessed and the results of treatment were recorded. RESULTS: Preoperative diagnosis was correct in all the cases except one (1.9%). Patients presented with abdominal pain (100%), weight loss (76%), vomiting (30%), and jaundice (18%). CT, MRI, and endoUS were the most useful diagnostic modalities. Ten patients were treated conservatively, 24 underwent pancreaticoduodenectomies (PD), pancreatico- and cystoenterostomies (8), Nakao procedures (5), duodenum-preserving pancreatic head resections (5), and 10 pancreas-preserving duodenal resections (PPDR) without mortality. Full pain control was achieved after PPRDs in 83%, after PDs in 85%, and after PPPH resections and draining procedures in 18% of cases. Diabetes mellitus developed thrice after PD. CONCLUSIONS: PD is the main surgical option for PP treatment at present; early diagnosis makes PPDR the treatment of choice for PP; efficacy of PPDR for DD treatment provides proof that so-called PP is an entity of duodenal, but not "paraduodenal," origin.