Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 7 de 7
Filter
Add more filters










Database
Publication year range
1.
Khirurgiia (Mosk) ; (5): 5-11, 2020.
Article in English, Russian | MEDLINE | ID: mdl-32500683

ABSTRACT

OBJECTIVE: To evaluate the long-term outcomes of surgical treatment of intrahepatic cholangiocarcinoma depending tumor dimensions, vascular invasion, lymph node metastases, cellular differentiation and quality of resection. MATERIAL AND METHODS: There were 46 patients with intrahepatic cholangiocellular cancer. Extended hemihepatectomy was made in 14 patients (30.4%), resection of two and three liver segments - in 17 cases (36.9%), standard hemihepatectomy - in 15 patients (32.6%). Liver resection was combined with extrahepatic bile duct resection in 5 (10.9%) patients. Liver resection was followed by biopsy of specimens. Dimension and number of tumors, differentiation grade, resection margin, liver capsule invasion, vascular invasion and regional lymph node metastases were analyzed. Forty-four (95.6%) patients were followed-up in long-term postoperative period. Statistical analysis was performed using Statistica 13.2 (Dell Inc., USA) and IBM SPSS Statistics v.25 (IBM Corp., USA) software package. Survival was analyzed using the Kaplan-Meier method. Overall 1-, 3- and 5-year survival rates with two-sided 95% confidence intervals (95% CI) were calculated using IBM SPSS Statistics v.25 software. RESULTS: Median survival was 37 months, 1-year - 75.9% (60.9-90.9%), 3-year - 57.6% (35.5-79.6%), 5-year - 36% (8.2-63.7%). Median survival after R1 resection was 37 months, R2 resection - 12 months. Median survival was not achieved in R0 group. We found significant differences in overall survival depending on quality of resection. Tumor dimension over 5 cm, low-grade adenocarcinoma, microvascular invasion and lymph node metastases were associated with impaired postoperative survival. However, differences were not significant. CONCLUSION: The main surgical strategy in patients with intrahepatic cholangiocarcinoma should be ensuring microscopically negative resection margin.


Subject(s)
Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic/surgery , Cholangiocarcinoma/surgery , Hepatectomy/methods , Bile Duct Neoplasms/pathology , Bile Ducts, Intrahepatic/pathology , Cholangiocarcinoma/pathology , Humans , Margins of Excision , Retrospective Studies , Survival Rate , Treatment Outcome
2.
Khirurgiia (Mosk) ; (10): 5-11, 2018.
Article in Russian | MEDLINE | ID: mdl-30531729

ABSTRACT

AIM: To determine significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma. MATERIAL AND METHODS: Analysis included 49 out of 84 patients who were operated at the Vishnevsky Institute of Surgery in 2003-2016. Morphological examination (2011-2016) revealed great percentage of following positive variables: micro- (42.9%) and lymphovascular invasion (11.8%), positive resection margin (59.2%), perineural invasion (83.3%), depth of invasion - (83.3%), cells in surrounding fatty tissue (92.3%), invasion of entire thickness of bile ducts' walls (57.1%). Hemihepatectomy was carried out in 50 (59.5%) cases, advanced hemihepatectomy - in 16 (19%) patients. Left-sided hemihepatectomy (34.6%) was more common compared with right-sided hemihepatectomy (8.6%) for biliary confluence lesion (Bismuth-Corlette type IV). RESULTS: TNM stage (p=0.29), tumor localization Bismuth-Corlette type (p=0.10), regional lymph nodes metastases (p=0.77) do not significantly affect survival in univariate analysis. At the same time, TNM stage was significant factor if patients dividing into groups was considered (p=0.05). In regression analysis tumor cells differentiation (p=0.00028), positive resection margin (p=0.0034), perineural invasion and depth of invasion (p=0,00086) were significant predictors of survival. Multivariate analysis confirmed prognostic role of lymphovascular invasion alone (p=0.05). There was no correlation between survival and TNM stage (η=0.057), depth of invasion (η= -0.229) and lymphovascular invasion (η= -0.143645). There was significant reverse moderate correlation between survival and perineural invasion (η= - 0.468750), resection margin (η= -0.558) and tumor differentiation grade (η= -0.481). CONCLUSION: Significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma are TNM stage, lymphovascular invasion, tumor cells differentiation, perineural invasion.


Subject(s)
Bile Ducts, Intrahepatic , Cholangiocarcinoma , Klatskin Tumor , Bile Duct Neoplasms , Hepatectomy , Humans , Retrospective Studies
3.
Khirurgiia (Mosk) ; (9): 5-14, 2018.
Article in Russian | MEDLINE | ID: mdl-30307415

ABSTRACT

AIM: To present own experience of pancreatic surgery and to analyze literature data for this issue. MATERIAL AND METHODS: We have analyzed work of abdominal surgery department over the last 5 years. Moreover, MEDLINE and RSCI databases regarding surgical treatment of pancreatic diseases were assessed. RESULTS: There were 456 pancreatectomies. Postoperative complications arose in 176 (38.6%) patients, 11 patients died (2.4%). According to world data, mortality after pancreatectomy reaches 10%. Only creation of specialized centers is proven way to improve the outcomes. CONCLUSION: Current medical assistance for pancreatic disease may be only achieved in specialized centers with large number of various pancreatic procedures. The organization of such centers is required throughout the country and certain accreditation criteria should be developed for this purpose. Targeted routing of patients to specialized pancreatology centers will be able to reduce incidence of diagnostic, tactical and technical errors.


Subject(s)
Hospitals, Special , Pancreatectomy/adverse effects , Pancreatectomy/mortality , Pancreatic Diseases/surgery , Hospitals, Special/organization & administration , Hospitals, Special/standards , Hospitals, Special/statistics & numerical data , Humans , Pancreatectomy/standards , Pancreatectomy/statistics & numerical data , Pancreatic Diseases/epidemiology , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Referral and Consultation/standards , Tertiary Healthcare/standards
4.
Khirurgiia (Mosk) ; (8): 4-11, 2018.
Article in Russian | MEDLINE | ID: mdl-30113586

ABSTRACT

AIM: To develop new criteria of radical surgery for hilar cholangiocarcinoma (HCC). MATERIAL AND METHODS: There were 165 HCC patients who underwent surgery in 1986-2016 at the Vishnevsky Institute of Surgery. TNM stage distribution: stage I - 4 (2.4%), II - 45 (27.3%) (29 of them are referred to the 1st period of work), IIIA - 23 (13.9%), IIIB - 41 (24.8%), IVA - 35 (21.2%), IVB - 17 (10.3%). 80 (48%) patients underwent hemihepatectomy, 17 (10%) - advanced hemihepatectomy, 16 (10%) - minor liver resection with common bile duct repair, 52 (32%) - common bile duct repair resection. Kaplan-Meier survival analysis was performed. Cox proportional hazard model was applied to access relationship between survival and prognostic factors. Log-rank test was used to compare both survival curves. RESULTS: R0-resection as followed by 5-year survival rate near 32%. Microvascular invasion was observed in 42.9%, lymphovascular invasion - in 88.2%, positive resection margin - in 59.2%, perineural invasion - in 83.3%, cells in surrounding fatty tissue were revealed in 92.3%. Resection may be considered radical (R0) if all variables are absent, 5-7 negative factors are followed by conditionally radical procedure (R+number of positive factors). Long-term outcomes and significance of new criteria were accessed (p=0.004). CONCLUSION: New criteria of radical procedure are presented. The last reflects the concept of dependence of 'pure' surgical edge from not only presence or absence of tumor cells in cut-off plane but also from important morphological features of tumor.


Subject(s)
Bile Duct Neoplasms/surgery , Hepatectomy , Klatskin Tumor/surgery , Bile Duct Neoplasms/mortality , Bile Duct Neoplasms/pathology , Common Bile Duct/pathology , Common Bile Duct/surgery , Hepatectomy/methods , Hepatectomy/mortality , Humans , Klatskin Tumor/mortality , Klatskin Tumor/pathology , Lymphatic Metastasis , Neoplasm Invasiveness , Retrospective Studies , Survival Analysis , Treatment Outcome
5.
Khirurgiia (Mosk) ; (10): 27-40, 2016.
Article in Russian | MEDLINE | ID: mdl-27804932

ABSTRACT

AIM: To optimize diagnostics and treatment of cystic liver tumors. MATERIAL AND METHODS: The analysis included outcomes of 46 patients with liver cystic tumors. RESULTS AND DISCUSSION: The use of abdominal Doppler-sonography (37 patients), abdominal contrast-enhanced CT (44 patients) and MRI of abdominal cavity with MR-cholangiography (24 patients) defined radiological semiotics of cystic liver diseases. The most important features of cystic tumors are intraluminal septums with blood flow (82% of patients), solid component (6.8%), daughterly cysts (11.3%), as well as biliary hypertension (39.2% of patients). Research of oncomarkers (CEA, SA 19-9, AFP) in 40 patients showed increased level of SA 19-9 only in case of cystadenocarcinoma and intraductal papillary mucinous neoplasm of biliary type. Benign and malignant cystic tumors had increased contents of oncomarkers in all cases. Surgical treatment was used in 42 patients. Extended liver resections were performed in 10 (23.8%) patients, atypical and anatomical resections (removal of less than 3 segments) - in 31 (73.8%) patients. In one case we applied cryoablation of CA in segment I of the liver in view of invasion into the wall of inferior vena cava and hepatoduodenal ligament. In 2 cases surgery was carried out laparoscopically. Also robot-assisted technique was used in 3 patients. Immunohistochemical study was performed in 22 (44.8%) patients. The diagnosis of CAC and biliary type of IPMN was confirmed in case of high expression of CK7, SK19, MUC1, S100p, SDH2, p53 antibodies. Cystadenomas were associated with moderate expression of ER, PR and p53 antibodies by stroma and CK7, SK19, CDX2, MUC1, S100p antibodies by epithelium. CONCLUSION: There are considerable difficulties of differential diagnosis of liver cystic tumors. Therefore, the use of single algorithm of diagnostics and treatment is necessary to confirm accurately the diagnosis at the perioperative stage. Cystic tumor is more likely to be assumed in women with solitary cyst in segment IV of liver. If the diagnosis is suspected or confirmed anatomical liver resection with complete tumor removal is necessary to prevent the recurrence.


Subject(s)
Cystadenocarcinoma, Mucinous , Cystadenoma, Mucinous , Hepatectomy , Liver Neoplasms , Liver , Neoplasm Recurrence, Local/prevention & control , Adult , Biomarkers, Tumor/blood , Cystadenocarcinoma, Mucinous/blood , Cystadenocarcinoma, Mucinous/diagnosis , Cystadenocarcinoma, Mucinous/pathology , Cystadenocarcinoma, Mucinous/surgery , Cystadenoma, Mucinous/blood , Cystadenoma, Mucinous/diagnosis , Cystadenoma, Mucinous/pathology , Cystadenoma, Mucinous/surgery , Diagnosis, Differential , Female , Hepatectomy/adverse effects , Hepatectomy/methods , Humans , Liver/diagnostic imaging , Liver/pathology , Liver Neoplasms/blood , Liver Neoplasms/diagnosis , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Magnetic Resonance Imaging/methods , Male , Middle Aged , Neoplasm Staging , Outcome and Process Assessment, Health Care , Tomography, X-Ray Computed/methods , Ultrasonography, Doppler/methods
6.
Angiol Sosud Khir ; 21(3): 159-65, 2015.
Article in Russian | MEDLINE | ID: mdl-26355938

ABSTRACT

Presented herein is a case report concerning tumorous thrombosis of the inferior vena cava and right atrium, which is rather an uncommon but severe complication of primary hepatic cancer. The purpose of the article is to demonstrate successful surgical management of locally disseminated hepatic carcinoma complicated by tumorous thrombosis of the inferior vena cava and portal vein, as well as thrombosis of the right atrium. The patient was subjected to dextral hemihepatectomy with thrombectomy from the right portal vein, resection of the right cupola of the diaphragm, marginal resection of the lower lobe of the right lung, thrombectomy from the inferior vena cava and right atrium. The outcome of our case report, as well as literature data suggest that in case of resectability of hepatic tumour complicated by thrombosis of major vessels and even the heart, surgical intervention is justified if there is a possibility to completely remove thrombotic masses along with the primary tumour.


Subject(s)
Budd-Chiari Syndrome , Carcinoma, Hepatocellular , Heart Atria , Hepatectomy/methods , Liver Neoplasms , Portal Vein , Thrombectomy/methods , Vena Cava, Inferior , Budd-Chiari Syndrome/diagnosis , Budd-Chiari Syndrome/etiology , Budd-Chiari Syndrome/physiopathology , Budd-Chiari Syndrome/surgery , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/physiopathology , Carcinoma, Hepatocellular/surgery , Echocardiography , Heart Atria/diagnostic imaging , Heart Atria/surgery , Humans , Liver Neoplasms/complications , Liver Neoplasms/pathology , Liver Neoplasms/physiopathology , Liver Neoplasms/surgery , Male , Middle Aged , Neoplasm Invasiveness , Neoplasm Staging , Portal Vein/diagnostic imaging , Portal Vein/surgery , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography, Doppler, Duplex , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery
7.
HPB Surg ; 4(1): 69-78; discussion 78-9, 1991 May.
Article in English | MEDLINE | ID: mdl-1911479

ABSTRACT

In the past five years, 16 adults (10 females, age 25-61 years, mean 48) with giant cavernous hemangioma of the liver measuring 15-31 cm (mean-19) underwent surgery in a single Institution. Diagnosis was made with the help of multimodal investigations- ultrasound (US), computed tomography (CT), hepatic angiography, hepatic scintigraphy and fine needle biopsy. Ultrasound and CT had sensitivities of 69% and 82% respectively. Fourteen had preoperative selective hepatic artery embolization to study its effect on operative blood loss. Indication for surgery in all cases was a large abdominal mass with varying severity of pain. In addition, 5 had hemetological and/or coagulation abnormalities, hemobilia in 1 and pyrexia in 1. Seven left lobectomies, 3 left lateral segmentectomies, 2 right lobectomies, 2 right trisegmentectomies and 4 non-anatomical resections of 1 to 3 segments were performed. Postoperative complications developed in 25% with no operative mortality. Preoperative selective hepatic artery embolization helped to decrease the operative hemorrhage in 13 (mean blood loss- 1146 ml). In two cases severe bleeding required use of Cell-saver and massive donor blood transfusion. Our results suggest use of preoperative selective hepatic artery embolization and Cell-saver as an adjunct to the liver resection for these vascular tumors.


Subject(s)
Blood Loss, Surgical/prevention & control , Embolization, Therapeutic , Hemangioma, Cavernous/surgery , Liver Neoplasms/surgery , Preoperative Care/methods , Adult , Female , Hemangioma, Cavernous/diagnosis , Hemangioma, Cavernous/pathology , Hemangioma, Cavernous/therapy , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Male , Middle Aged
SELECTION OF CITATIONS
SEARCH DETAIL
...