[Radical oncological stomach, liver and pancreatic surgery in patients over 80 years old]. / Radikal'nye onkologicheskie vmeshatel'stva na zheludke, pecheni i podzheludochnoi zheleze u patsientov v vozraste 80 let i starshe.

AIM: To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old. MATERIAL AND METHODS: For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection. We analyzed blood loss, duration of surgery, 90-day mortality, morbidity (Dindo-Clavien scoring), length of hospital-stay. RESULTS: Blood loss ranged from 0 to 1500 ml, mean duration of surgery - from 150 to 560 min. There was one case of in-hospital mortality: one patient after a Whipple procedure died in 17 days after surgery due to massive arrosive bleeding. Complications developed in 8 patients, 3 of them required reoperation. Mean hospital-stay was 15±6 (8-29) days. CONCLUSION: Advanced upper GI surgery for cancer is feasible in octagenarians and does not lead to inappropriate mortality and morbidity. Comprehensive preoperative examination alongside with enhanced recovery protocol are prerequisites for this type of surgery.

Radical surgical treatment of elderly patients with gastric cancer.

To analyze the early results of radical surgery for gastric cancer in patients > 75 years. In the period between Jan. 2013 and June 2015 there were 25 radical operations in elderly (≥ 75 years) patients with gastric cancer. The following outcomes are presented: bloodloss, duration of surgery, mortality and morbidiy according to Dindo-Clavien classification, length of stay. There were 12 total and 13 distal gastrectomies, including 8 laparoscopic procedures (2 - total laparoscopic gastrectomies), all with D2 lymph node dissection. Mean bloodloss constituted 50±64 ml (0-300 ml), mean duration of surgery 220±70 min (140-360 min). There was no in-hospital mortality, but one patient died 2 weeks after discharge because of an unclear intraluminal bleeding. Mild complications (Dindo-Clavien I-II) were found in 6 patients, severe in 11 patients. In 6 patients repeated laparotomies were necessary. Mean length-of-stay constituted 13±17 (5-63) days. Radical gastric cancer surgery in the elderly patients is feasible. A prerequisite is a thorough pre-operative examination. This type of surgery shall be practiced in highly specialized centers after detailled control of patients' comorbidity.

[Experience of two-staged liver resection (ALPPS)].

The aim was to estimate single center results of ALPPS. It was performed 5 ALPPS-procedures in our center during the period from February 2013 to March 2014. There were 1 female and 4 males in the age of 58-64 years. The indications for surgery were colorectal cancer metastases in 4 cases, bladder cancer metastases in 1 observation. The operations included 3 right-sided hemihepatectomies, 2 extended right-sided hemihepatectomies. In 3 cases operations were accompanied by additional atypical resection of residuary liver lobe. In 2 observations unsuccessful embolization of the portal vein was done. The waiting time between procedures consisted 18 days in the first case and 6 days in other cases. Final hepatectomy was performed in all observations. Hypertrophy of left liver lobe was more than 50% in all cases. Postoperative complications happened in 3 out of 5 cases. One patient died because of progressive thrombosis of inferior vena cava and developed multiorgan failure. There were 1 complication of level 2 and 1 complication of level 4a according to Dindo-Clavien classification. One patient had biliary fistula after final hepatectomy. It wasn't observed cases of severe liver failure. ALPPS is appropriate method for fast residuary liver lobe hypertrophy. It allows to perform R0-resection of liver but ALPPS has high postoperative complication rate.

[Hilar glissonean access to vascular-secretory elements in anatomical segmental liver resections].

It still remains unclear which patients with hepatic tumors can favour anatomical segmental liver resections instead of major liver resection. Short term results of anatomical segmental liver resection are evaluated and analyzed. Ten patients underwent the anatomical segmental liver resection performed by posterior approach with taping of anterior right hepatic vein. Seven patients had liver metastases of colorectal cancer, one had primary hepatic carcinoma and two had benign lesions, anatomical segmental liver resection were performed without Pringle maneuver. There was no significant difference in blood loss, duration of the procedure, postoperative hospital stay and morbidity in comparison with the segmental liver resection performed by anterior approach. Multiple, large and deep-embedded lesions were removed completely, with tumor-free resection margins. Anatomical segmental liver resection performed by hilar glissonean approach is recommended in patients with compromised liver function "unfavourable" liver anatomy to replace major liver resection provides removal of only affected part of the liver accordingly to its true anatomical borders.