[Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) - new opportunity in two-stage liver resection in patients with colorectal cancer metastases].

Major hepatic resection is often necessary for cure in patients with multiple colorectal cancer metastases but low future liver remnant (FLR) volume makes surgery risky because of the posthepatectomy liver failure (PHLF). Right portal vein ligation/embolization and two-stage hepatectomy were proposed previously to overcome this problem. Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel approach aimed for FLR volume hypertrophy. During the first stage right portal vein is ligated followed by liver parenchyma in situ splitting. Right liver lobe removal is performed during the second stage when FLR hypertrophy becomes sufficient. Three patients with colorectal cancer liver metastases were scheduled for major hepatic resection. ALPPS was applied because of insufficient FLR volume. We observed FLR hypertrophy of 77, 90 and 70% after 7, 7 and 14 days waiting period. FLR/Total Liver Volume ratio increased from 22, 23 and 15% to 33, 35 and 32% respectively. The second stage was performed successfully in all patients. All patients are alive and they have not disease relapse after 17, 15 and 15 months after surgery. ALPPS is promising technique that allows rapid FLR hypertrophy and enables curative liver resections in initially unresectable patients. But it is necessary more data concerning ALPPS safety and long-term results.

[Novel approach to two-stage hepatic surgery (in situ splitting)].

Two-stage liver surgery with preliminary right portal vein occlusion procedure (ligation or embolisation) became standard in clinical practice and allows liver resections in 60-82% of initially inoperable patients. Right portal vein ligation with concomitant liver partition in situ (in situ splitting, ISS) is innovatory and promising approach. Right portal vein ligation and in situ splitting was performed in 40 years old male with two metachronous rectal metastases in right liver lobe and insufficient volume of future liver remnant (22%). MRI on 7th postoperative day showed left liver lobe hypertrophy rate of 77% and left liver lobe volume increase from 22 to 33.5%. Right hemihepatectomy was performed on day 8 after the first stage. There were no signs of postoperative liver failure. Conclusion. New two-stage surgery approach (ISS) can decrease number of patients who were inoperable because of insufficient volume of future liver remnant and high risk of postoperative liver failure.

[The surgical hepatology in SCS: from the beginning to development].

The article highlights survey stakes of surgical hepatology in world and Russia, and the 20 years experience of the Russian Scientific Center of Surgery named after B.V. Petrovskiy. 472 liver resections were performed during the period. Main indications for surgery were malignant liver tumors, predominantly metastatic (75.8%). Technical and tactical questions, as well as treatment results were discussed. The issue compares own data with world's experience.

[Alveococcosis of liver: retrospective analysis of treatment of 51 patients].

51 patients with liver alveococcosis were operated on: radical operations with the whole hydatid tumor removal, cytoreductive operations with 50-80% of the tumor removal and alveococcal nodes' preserving on vital organs; and palliative manipulations, aimed the relief of complications were performed. According to the treatment results, the radical liver resection proved to be the most effective. When the complete tumor removal is impossible, cytoreductive operations are possible. Combination with antiparasitic therapy is required.

[The liver hemangioms: operation or observation].

The treatment results of 178 patients with liver hemangioms were analyzed. 322 liver hemangioms of the average size of 36,5 (4-350) mm were diagnosed in 178 patients. 50 (28%) patients were operated on. The largest operated lesion was 100mm. Basic indications to the surgical treatment were: symptomatic course of the disease (42%), unclear diagnosis (24%) and fast growth of the lesion (16%). The lethality rate was 2% (1 of 50), postoperative complications were registered in 24% (12 of 50). Tumor enucleation was performed in 12 (24%) cases, the liver resection - in 38 (76%). The long-term follow-up (average of 55 months) was achieved in 50%(89 of 178) patients. The were no symptoms of the disease in 88,5% of the operated patients and they disappeared in 84% of the non-operated patients. The majority of the patients with the nonsympomatic course of the disease showed anuy negative dynamics of the process. Thus, in 85,2% there were no hemangiom growth registered, 11,1% demonstrated the enlargement of the lesion on 13-38 mm, and 3,7% showed the smaller diameter of the tumour. The study highlights the seldom necessity of the operative treatment of liver hemangioms: by severe symptoms, unclear diagnosis and the fast tumour growth. The enucleation of the tumor is preferable to the liver resection. The exact diagnosis permits the long observance with the ultrasound control as often as once a year.

[The treatment of the sponateneous biloma and choledocholithiasis after the liver resection on the reason of the giant hemangioma].

Patient with giant rapidly growing liver hemangioma who carried out right hemihepatectomy is reported. The feature if this case is choledocholithiasis after liver resection followed by its rare complication (spontaneous biloma) in 6 years after surgery. Minimally invasive procedures (percutaneous drainage, endoscopic papillotomy and stenting) eliminated each of bile collection and cause of biliary obstruction without surgical intervention.

[True cystic tumors of the pancreas].

Retrospective analysis of treatment results was carried out in 37 patients that had been treated during 1984-2009 years. Mean age of the patients was 50.7 years; among them 94.6% were women. 8 (21.6%) patients had serous cystadenoma, 21 (56.8%) patients - mucinous cystadenoma, 7 (18,9%) patients - cystadenocarcinoma and 1 (2.7%) patient - intraductal papillary-mucinous tumor. Distal pancreatic resection was carried out to 19 patients, pancreatoduodenal resection - in 5 patients, enucleation - in 10 patients, midline resection - in 1 patient, pancreatectomy - in 2 patients. The frequency of complications amounted 35.1%; lethal outcomes were not observed. Pancreatitis (in 7 patients) and pancreatic fistula (in 4 patients) were the most common complications. Re-laparotomy was necessary for destructive pancreatitis in 2 observations. Other complications were treated conservatively. Long-term results were studied in 28 (76%) patients. Mean duration of the observation was 87,3 months (6-120 months). 5-year survival rate amounted 100% among patients with benign cystic tumors of the pancreas and 25% in patients with cystadenocarcinoma. It is drawn a conclusion that complete recovery is quite possible in patients with benign tumors whereas treatment of the patients with invasive cystadenocarcinoma demonstrate poor results in long-term period.

[Methodology of clinical studies in surgery].

Results of clinical studies recently became the guidelines in decision making in medicine including surgical practice. Results of each study could be used generally only if all methodological requirements are fulfilled. In this paper the principles of clinical studies design particularly in surgery and medical publications analysis are described and discussed.