[Multiple hepatocellular adenomas and renal cell carcinoma associated with anabolic androgenic steroids]. / Mnozhestvennye gepatotsellyulyarnye adenomy i pochechnokletochnyi rak, assotsiirovannye s priemom bodibilderom anabolicheskikh androgennykh steroidov.

The authors report a rare case of combination of chromophobe renal cell carcinoma Grade 2 pT2aN0 with multiple hepatocellular adenomas in a 31-year-old bodybuilder who received anabolic androgenic steroids at high doses for 8 years. According to MRI data, over 15 liver adenomas and tumor in the lower segment of the right kidney were detected. The patients underwent laparascopic resection of the right kidney and liver segments 2, 3 and 4 with large adenomas. Histological study and immunohistochemistry revealed no malignancy signs in hepatocellular adenomas. Nuclear ß-catenin expression was absent. Kidney tumor had a structure of chromophobe renal cell carcinoma. The patient is currently being followed-up due to residual small liver adenomas. In our opinion, liver adenomatosis and renal cancer have the same cause in this case (chronic toxic effect of androgens).

[Short-term results of pancreatoduodenectomy in patients over 70 years old]. / Blizhaishie rezul'taty posle pankreatoduodenal'nykh rezektsii u patsientov v vozraste 70 let i starshe.

OBJECTIVE: To analyze the immediate results of PDE in patients younger and older 70 years. MATERIAL AND METHODS: The study included patients who underwent PDE for various indications from March 2010 to February 2019. All patients are divided into 2 groups: <70 years old and ≥70 years old. Primary endpoints were postoperative mortality and complication rate. RESULTS: There were 110 procedures within 9 years. There were 93 patients aged <70 years (group 1) and 17 patients aged ≥70 years (group 2). ASA (American Society of Anesthesiologists) and PMP scores (Preoperative Mortality Predictor) were higher in group 2: 3 (2-3) vs 2 (1-3) (p=0,002) and 12 (6-15) vs 6.5 (5-15) (p<0.001), respectively. Mortality rate was higher in group 2 (11.7% vs. 3.2%) without statistical significance (p=0.16). Overall morbidity (72% vs 76%; p=1.0), incidence of major complications grade ≥IIIa (29% vs 29%), delayed gastric emptying B/C (17.2% vs 17.6%), pancreatic fistula grade B/C (23.6% vs 35.3%, p=0.3), biliary fistula grade B/C (7.5% vs 11.8%; p=0.62), postoperative hospital-stay [22 (8-165) days vs 23 (9-71) days; p=0.92] were comparable in both groups. CONCLUSION: Short-term results of PDE in patients aged <70 and ≥70 years are comparable despite higher ASA and PMP scores in the group 2. General status and concomitant diseases should be considered during selection of patients with resectable tumors for PDE. Age per se is not a contraindication for surgery.

[The role of lymphadenectomy for treatment of colorectal liver metastases with regional lymph nodes involvement]. / Rol' limfadenéktomii v lechenii metastaticheskogo kolorektal'nogo raka pecheni s porazheniem regionarnykh limfaticheskikh uzlov.

Liver resection remains the method of choice for treatment of colorectal liver metastases with good long-term results. Regional lymph nodes involvement is significant negative prognostic factor. Moreover, it has been considered as a contraindication for liver resection for a long time. The role of lymphadenectomy remains controversial. Current state of this problem is reviewed in the article. Liver regional lymph nodes involvement takes place in 10-20% of cases. PET/CT is the most sensitive method of preoperative diagnosis. Involvement of liver regional lymph nodes is currently not absolute contraindication for liver resection. Routine lymphadenectomy does not make sense, and, perhaps, is justified only within scientific trials for more accurate disease staging. Indications for lymphadenectomy are suspicious changes of lymph nodes revealed by preoperative visualization methods or by intraoperative exploration. Modern chemotherapy regimens allow to reconsider the prognostic importance of liver regional lymph node metastases and to extend indications for liver resections.

[Surgical management of non-functioning pancreatic neuroendocrine tumors]. / Taktika khirurgicheskogo lecheniia nefunktsioniruiushchikh neiroéndokrinnykh opukholei podzheludochnoi zhelezy.

AIM: To analyze immediate and long-term results of surgical treatment of patients with non-functioning pancreatic neuroendocrine tumors (pNETs). MATERIAL AND METHODS: Outcomes in 21 patients with non-functioning pNETs were retrospectively analyzed. RESULTS: Long-term results were followed-up in 18 (85%) cases, median follow-up was 39 months. Postoperative mortality was 4.7%. The incidence of postoperative complications Clavien-Dindo degree IIIA and over was 20.8%, overall 5-year survival - 89%, desease-free 5-year survival - 78%. CONCLUSION: At present time surgical intervention remains the only radical method of non-functioning pNETs management. Threshold tumor dimension should be 15 mm that determines surgical intervention or active surveillance. From an oncological point of view tumor enucleation is permissible only in case of small dimensions (up to 2 cm) and full confidence in low degree of malignancy. Lymphadenectomy should be performed in all cases in standard fashion because lymph node involvement is reliably poor prognostic sign.

[Isolated pancreatic metastases of renal cell carcinoma]. / Izolirovannye metastazy pochechno-kletochnogo raka v podzheludochnuiu zhelezu.

AIM: To present own experience of surgical treatment of isolated pancreatic metastases of renal cell carcinoma. MATERIAL AND METHODS: There are 3 cases of pancreatic metastases of renal cell carcinoma. They were diagnosed in women aged 55, 66 and 67 years in 9, 11 and 23 years after nephrectomy respectively. RESULTS: The tumors were placed in head (60 mm), body (10 and 5 mm) and tail (30 mm) of the pancreas. There were 2 distal pancreatectomy with splenectomy and 1 pancreatoduodenectomy. All patients are alive within 39, 49 and 8 months after surgery respectively. One woman has been diagnosed pulmonary metastases after 19 months. 20-month sunitinib administration contributes to regression of the disease. There was no recurrent disease in other two patients. CONCLUSION: Isolated pancreatic metastases of renal cell carcinoma can occur in decades after nephrectomy. Therefore, lifelong follow-up is necessary. Pancreatectomy for focal lesion is associated with good long-term outcome.

[Von Hippel-Lindau disease type 2-related pancreatic neuroendocrine tumor and adrenal myelolipoma].

The paper describes a case of von Hippel--Lindau-related pancreatic neuroendocrine tumor and adrenal myelolipoma in a 44-year-old woman. The pancreatic tumor and a left retroperitoneal mass were removed in the women in July 2014 and May 2015. Histological examination of the pancreatic tumor revealed that the latter consisted of clear cells forming tubular and tubercular structures showing the expression of chromogranin A, synaptophysin, and cytokeratins 18 and 19 and a negative response to CD10 and RCC. The adrenal medullary mass presented as clear-cell alveolar structures with inclusions of adipose tissue mixed with erythroid, myeloid, and lymphoid cells. The clear-cell component of the adrenal gland expressed neuroendocrine markers with a negative response to cytokeratins, CD10, and RCC. Molecular genetic examination yielded a signal corresponding to two copies of the VHL gene. No deletions or amplifications of the gene were detected. Cases of von Hippel--Lindau disease concurrent with adrenal pheochromocytoma and myelolipoma and simultaneous pancreatic involvement were not found in the literature.

[Radiofrequency ablation in combined treatment of metastatic colorectal liver cancer]. / Radiochastotnaya ablyatsiya v kombinirovannom lechenii metastaticheskogo kolorektal'nogo raka pecheni.

AIM: To study surgical and oncological outcomes in patients with metastatic colorectal liver cancer who underwent radiofrequency ablation in the structure of combined approach. MATERIAL AND METHODS: It is a prospective analysis of treatment of 76 patients with metastatic colorectal liver cancer who underwent RFA for the period 2004-2013. Overall survival was analyzed using univariate and multivariate analysis. RESULTS: According to univariate analysis overall 5-year survival is negatively determined by following factors: primary localization of the tumor in rectum (36.2% and 7.2%; p=0.021); bilobed metastatic liver disease (35.9% and 15.4%; p=0.068); metastases dimensions over 5 cm (27.4% and 0%, p=0.091); augmentation of CAE levels over 4 norms (26.7% and 11.4%, p=0.09); RFA as a component of two-stage liver surgery (23.3% and 26.0%, p=0.09). CONCLUSION: RFA is an effective method of local antineoplastic effect for metastatic colorectal cancer. Dimensions of coagulated metastases, volume of metastatic lesion, carcinoembryonic antigen level, ablation as a component of two-stage surgery affect long-term survival after RFA.

[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.

[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.

[Radiological diagnosis of liver hemangiomas: look at the problem of surgical clinic].

AIM: To define significance of radiological diagnostics in detection and characterization of hepatic hemangiomas. MATERIALS AND METHODS: Analysis of 176 patients with liver hemangiomas was performed. All patients were investigated or consulted in hepato-pancreato-biliary surgical department. US, CT, MRI, angiography, scintigraphy and liver biopsy were compared. RESULTS: Contemporary noninvasive diagnostics disclose liver hemangiomas with high confidence without need for tumor biopsy. MRI and CT with intravenous enhancement are the most efficient modalities for detection of hepatic hemangiomas.