[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

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.

[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.

[Comparative analysis of static scintigraphy and computerized tomography in assessment of remnant liver volume after advanced hepatic resection]. / Cravnitel'nyi analiz staticheskoi stsintigrafii i komp'iuternoi tomografii v otsenke ob''ema ostatochnoi parenkhimy pri obshirnykh porazheniiakh pecheni.

AIM: To perform a comparative analysis of computerized tomographic volumetry and scintigraphic liver volumetry in assessment of remnant liver volume after advanced hepatic resection. MATERIAL AND METHODS: Static hepatobiliary scintigraphy and CT volumetry were performed in 45 patients with various liver tumors who underwent advanced hepatectomies (more than three segments). RESULTS: There were no any significant differences in volumetric parameters obtained by CT and scintigraphic volumetry. CONCLUSION: Scintigraphic volumetry data are similar to those of CT volumetry in evaluation of future remnant liver volume. Scintigraphic volumetry may be used as an alternative in assessment of future remnant liver volume after advanced hepatic resections.

[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.