[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.

[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.

[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.

[Results of surgical treatment of benign strictures of extrahepatic bile ducts].

UNLABELLED: The main reason of benign biliary strictures is the traumatic bile duct injuries during laparoscopic or open cholecystectomy. Although there are growing possibilities of interventional endoscopic treatment of such pathology the definitive operative drainage is in many cases the therapy of choice. There were analyzed the short- and long-term results of surgical reconstruction in 160 patients with of benign strictures of hepaticocholedochus. Complication rate was 12,5%, mortality 2,5%. Median follow-up period was 53,6+/-51,3 month, good and satisfactory long-term results were observed in 76%. There were revealed two factors, predicting poor outcome: biliary fistula (R=0,31; p=0,0053) and reoperations (R=0,309; small er, Cyrillic=0,0058). CONCLUSION: biliodigestive anastomosis is method of choice for treatment of benign biliary strictures of hepaticocholedochus. Hepaticojejunostomy with Roux-en-jejunal limb is more preferable variant of reconstruction for treatment of benign biliary strictures of HC. Good long-term results can be achieved in most part of the patients. In patient with not wide bile ducts and in technically difficult cases transhepatic biliary drainage is acceptable.

[Surgical treatment of major duodenal papilla neoplasm]. / Opyt kliniki v khirurgicheskom lechenii raka bol'shogo sosochka dvenadtsatiperstnoi kishki.

Immediate and long-term results of pancreatoduodenal resections in 33 patients undergone surgery for adenocarcinoma of bile papilla from 1984 to 2003 were studied. Majority of patients had II and III stages of diseases. Correct diagnosis before surgery was made in 27 (81.8%) patients. Morphologic study revealed metastasis in 11 patients. Lethality was 9.1%, moreover last 18 pancreatoduodenal resections had no lethal outcomes. Long-term results were studied in 25 (83.3%) patients: 1-year survival was 90.4%, 3, 5 and 10 years survived 71.4, 61.2 and 51% patients respectively. Only metastatic lesion of lymph nodes and later stage of disease had negative influence on long-term results. Such factors as gender, diameter of carcinoma, lymphadenectomy and pylorus-saving variant of surgery did not influence on long-term results. It is concluded that pancreatoduodenal resection must be surgery of choice in the treatment of resected cancer of bile papilla.

[Surgical policy in patients with chronic calculous cholecystitis complicated by choledocholithiasis]. / Khirurgicheskaia taktika u bol'nykh khronicheskim kal'kuleznym kholetsistitom, oslozhnennym kholedokholitia.

Results of surgical treatment in 116 patients with chronic calculous cholecystitis complicated by choledocholithiasis were studied. Introduction in clinical practice of endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy changed surgical policy for benign combined lesions of gall bladder and extrahepatic bile ducts. Complex endoscopic treatment is preferable if contraindications are absent. Complex endoscopic treatment was used in 26.7% cases, combined surgical and endoscopic (trans-papillar surgeries) - in 30.2%, conventional surgical - in 33.6%. Isolated EPST and endo-biliary procedures were performed in 9.5% patients. Complex endoscopic treatment is preferable for chronic calculous cholecystitis complicated with choledocholithiasis. Combined and conventional surgical policy is indicated when appliance of endoscopic technologies is not possible.

[Treatment and prevention of cicatricial strictures and fistulas of biliary ducts]. / Lechenie i profilaktika rubtsovykh striktur i svishchei zhelchnykh protokov.

The paper summarizes the experience gained by the Department for Surgery of the Liver, Biliary Ducts, and Pancreas, Surgery Research Center, in treating patients with corrosive strictures and fistulas of the biliary ducts since 1967. It considers the causes of this abnormality, the nature of corrective operations on the great biliary ducts, complications due to the type of a surgical intervention. Analyzing the reasons for poor postoperative outcomes provides the optimal time of carcass drainages, the optimal diameter of the biliodigestive anastomosis made to have good results. Emphasis is laid on the specific features of biliary surgery if there are profound inflammatory and infiltrative or scarry and commissural changes in the hepatoduodenal ligament to prevent possible damage to the great biliary ducts.

[An algorithm for differential diagnosis searching in space-occupying lesions of the liver]. / Algoritm differentsial'no-diagnosticheskogo poiska pri ob''emnykh obrazovaniiakh pecheni.

The experience of examination of 584 patients with volumetric masses of the liver (VML) of various origin is presented. For successful differential diagnosis of VML and definition of rational surgical policy the algorithm of examination was considered with due regard for diagnostic stages, each of them being characterized by definite complex of tests. It is thought necessary to begin examination with noninvasive and highly informative tests. Complex of radioimmunologic evaluation of tumor markers level is advisable to include in diagnostic algorithm of patients with VML. The use of invasive methods of diagnostics is justified in complicated diagnostic situation. For evaluation of regional function of the liver radionuclear examination should be used. Liver puncture are feasible only whenever parasitic nature of cystic masses of the liver is excluded. If it is found to be impossible to determine the character of VML the question of advisability of diagnosis laparotomy should be resolved in its favour. The most efficient use of various methods of examination in 584 patients with VML of various genesis made it possible to increase accuracy of diagnosis of hepatic hemangioma, in nonparasitic cysts--1.7 times and in parasitic cysts--1.2 times.

[Congenital cystic diseases of liver and extrahepatic bile ducts]. / Vrozhdennye kistoznye porazheniia pecheni i vnepechenochnykh zhelchnykh protokov.

The paper presents 30-year experience in treating 158 patients with congenital cystic diseases of the liver and bile ducts. Depending on the pattern of hepatobiliary lesions, the diagnostic value of techniques, such as ultrasound, computerized tomography, scintigraphy of the liver duodenoscopy with THCG was defined. Analyzing the late outcomes provided recommendations for the most optimal surgical management: cystic fenestration and tunneling in hepatic polycystosis, pericystectomy in solitary cysts of the liver, different varieties of bile draining operations in choledochal cysts and Caroli's disease.

[Methods of correction and prevention of cicatricial strictures and fistulas of the bile ducts]. / Metody korrektsii i profilaktika rubtsovykh striktur i svishchei zhelchnykh protokov.

Two hundred and eighty one patients with cicatricial biliary strictures were examined to reveal external biliary fistulas in 72 of the patients. The strictures and fistulas developed after surgery on the stomach and biliary ducts due to an accidental surgical injury to these organs, or at later terms after a ++hepato-choledochal intervention. The biliary lesions were repaired with 149 operations with formation of a biliodigestive anastomosis without tube drainage, 117 with tube drainage (mostly transhepatic), six plastic operations with reconstruction of the ++hepato-choledochal integrity, and 47 ++radio-endoscopically guided interventions. Complications after cavitary++ operations were observed in 36.9 per cent cases with the fatal outcome in 13 of the patients (4.7 per cent). ++Radio-endoscopically guided interventions included: radioendobiliary prosthetics of the biliary ducts, recanalization, balloon dilatation of short strictures with endoscopic guidance, elimination of concretions by means of external drainage, and endoscopic papillosphincterotomy in distal choledochal strictures. Long-term findings were related to the level of the biliary lesion, the period that had elapsed since the stricture formation, and the number of operations in the medical history. Good or satisfactory results were achieved in 87.9 per cent cases. Considering the results of treatment for biliary strictures and fistulas disappointing, the main effort should be aimed at their prophylaxis. With this purpose, measures to prevent surgical injury to the biliary tract have been elaborated.