Right-sided Hemihepatectomy Research Articles

Coagulological disorders during liver resections in patients with malignant tumors

The purpose of the study. To study the coagulation profile of patients undergoing liver resections using laboratory tests and thromboelastography. Materials and methods. The results of observation of coagulological changes in 45 patients were studied: with colorectal liver metastases - 24 (53.3%) cases, with hepatocellular cancer - 14 (31.1%), with cholangiocellular cancer - 7 (15.6%). Right-sided hemihepatectomy was performed in 22 (48.9%) patients, right-sided extended hemihepatectomy - in 7 (15.6%), left-sided hemihepatectomy - in 8 (17.8%), resection of the left sector - in 8 (17.8%). Laboratory diagnostics included standard conventional coagulation tests and thromboelastography. Results. The concentrations of total bilirubin and alkaline phosphatase significantly increased up to 3 days of the postoperative period inclusive. The international normalized ratio increased significantly after liver resection immediately after surgery, as well as after 1, 3 and 5 days of observation. The level of fibrinogen in the first day after surgery decreases, and then increased to the initial value. Thromboelastometric parameters indicated a stable and normal coagulation function with a short ability to hypercoagulate immediately after liver resection. Conclusion. Although standard routine laboratory tests such as activated partial thromboplastin time and international normalized ratio may remain within normal limits or indicate hypocoagulation, the patient may be at risk for thrombosis. Thromboelastography measures the rate of formation, stabilization, and lysis of a clot using whole blood, which gives a more complete picture of coagulation status. Thus, routine laboratory parameters alone should not be used to decide whether to delay thromboembolic prophylaxis after liver resection.

Right-sided hemihepatectomy after endovascular vascular isolation of the right lobe of the liver

Right-sided hemihepatectomy after endovascular vascular isolation of the right lobe of the liver

Blebbing of the plasma membrane of lymphocytes as a marker of endothelial dysfunction in the development of post-resection insufficiency in patients with focal liver lesions

Purpose of the study. To evaluate the intensity of blebbing of the plasma membrane of lymphocytes and the formation of microparticles of lymphocytic origin in patients with postresection hepatic failure. Material and methods. The study involved 54 patients with focal liver diseases. The study involved 32 (59%) women, 22 (41%) men. The average age was 59.5 [49.75; 66,00]. Patients were divided into groups, 1 group - 10 patients with developed acute liver failure and 2 group - 44 patients with a favorable course of postoperative period. The following surgical interventions were performed: 36 (67%) patients underwent surgery - laparotomy, segmental liver resection, 10 (18%) - left-sided hemihepatectomy and 8 (15%) - right-sided hemihepatectomy. Results. Predictors of early postoperative hepatic failure are a decrease in initial blebbing and an increase in terminal blebbing and free microparticles of lymphocytic origin. Conclusions. Thus, changes in lymphocyte blebbing and the presence of free microparticles of lymphocytic origin are due to the development of endothelial insufficiency and apoptosis of lymphocytes in the context of liver failure and are determined by the reduced function of residual liver volume.

Pancreatic Perivascular Epithelial Cell Tumor (PEComa) with Liver Metastasis: a Case Report and Literature Review

Aim: to present a clinical case of pancreatic PEComa with liver metastases with an emphasis on morphological features, radiology diagnostic methods and features of treatment tactics, allowing practitioners to get an idea about this rare mesenchymal tumors composed of “perivascular epithelioid cells”, and a review of literature data on pancreatic PEComa, including 32 author's cases.General statements. A 22-year-old woman who was surgically treated for pancreatic head PEComa with infiltration of the duct of Wirsung, common bile duct, duodenal wall, focal invasion into the blood and lymphatic vessels, and perineural space infiltration. Synchronously, metastases were detected in both liver lobes, for which she took Everolimus for 6 years under the control of radiology methods with dose adjustment and frequency of administration. At the A.V. Vishnevsky National Medical Research Center of Surgery, the patient underwent right-sided hemihepatectomy and atypical resection of II-III liver segments.Conclusion. To determine clearer criteria for the diagnosis and differential diagnosis of PEComa, to identify criteria for the malignancy of these tumors, to develop treatment tactics and further dynamic monitoring, a set of statistical data of significant group and randomized clinical trials are needed. Pancreatic PEComas in this group are extremely rare and often have a benign course. The presented clinical case demonstrates the most malignant form of this tumor with localization in the pancreas and liver metastases.

Living-related partial liver transplantation in unresectable liver metastatic colorectal cancer. A case report

Aim. The purpose of the article is to study the outcome of using living-related partial liver transplantation in the treatment of unresectable liver metastatic colorectal cancer. Case report. A woman, born in 1989, applied to the Medical Center Universal Clinic “Oberig” with a diagnosis of stage IV sigmoid colon cancer pT4N2M1 with synchronous liver metastases after sigmoidectomy and adjuvant chemotherapy. The patient underwent surgical intervention to the extent of right-sided hemihepatectomy with total caudate lobectomy, enucleation of metastases from the left liver lobe, cholecystectomy, extended lymphadenectomy, followed by systemic antitumor therapy. Six months later, according to laboratory and instrumental examinations, the progression of the disease was revealed in the form of new metastases development in the left liver lobe. After a thorough examination, a decision was made to treat the patient by living-related partial liver transplantation. On February 16, 2021, the patient underwent orthotopic transplantation of the left liver lobe from a living-related donor. The patient was discharged on the 31st postoperative day in a satisfactory condition. According to a control MRI after discharge, no signs of disease progression were detected. In the post-transplantation period, the patient developed an acute steroid-resistant rejection requiring antiplatelet immunoglobulin prescription. Three months after discharge, the patient was diagnosed with a high stricture of the bilio-biliary anastomosis, so resections of liver segment IV, hepaticocholedochus, and bihepaticojejunostomy on a defunctionalized Roux loop of the small intestine were performed. In the post-transplantation period, no signs of disease progression were detected, and no special antitumor treatment was used. Conclusions. Liver transplantation is an effective and radical method of treatment for patients with unresectable liver metastatic colorectal cancer.

Successful Combined Treatment of a Patient with Borderline Resectable Liver Metastasis of Colorectal Cancer

Aim: to present the value of interventional radiology techniques in the treatment of a patient with liver metastasis of colorectal cancer.Key points. In 2013, a 60-year-old patient with stage IIIB sigmoid colon cancer, pT3N2M0 underwent resection of the sigmoid colon with the formation of hardware rectosigmoanastomosis, 6 courses of adjuvant chemotherapy were performed. In 2015, a control examination revealed metastatic liver damage. Liver resection could not be performed due to the small future residual volume, and systemic chemotherapy was not effective. The patient underwent 3 cycles of regional chemotherapy. Taking into account the pronounced positive dynamics, in the form of a decrease in tumor size and a decrease in cancer markers, the patient managed to perform an extended right-sided hemihepatectomy. No progression of the tumor process was detected during the follow-up.Conclusion. Modern possibilities of X-ray endovascular methods allow to achieve results in the treatment of patients with colorectal cancer metastases in the liver such as a decrease in metastases in size, that make liver resection possible.

Impact of post-hepatectomy liver failure on morbidity and short- and long-term survival after major hepatectomy.

BackgroundPost-hepatectomy liver failure (PHLF) is one of the most serious postoperative complications after hepatectomy. The aim of this study was to assess the impact of the International Study Group of Liver Surgery (ISGLS) definition of PHLF on morbidity and short- and long-term survival after major hepatectomy.MethodsThis was a retrospective review of all patients who underwent major hepatectomy (three or more liver segments) for various liver tumours between 2010 and 2018 at two Swedish tertiary centres for hepatopancreatobiliary surgery. Descriptive statistics, regression models, and survival analyses were used.ResultsA total of 799 patients underwent major hepatectomy, of which 218 patients (27 per cent) developed ISGLS-defined PHLF, including 115 patients (14 per cent) with ISGLS grade A, 76 patients (10 per cent) with grade B, and 27 patients (3 per cent) with grade C. The presence of cirrhosis, perihilar cholangiocarcinoma, and gallbladder cancer, right-sided hemihepatectomy and trisectionectomy all significantly increased the risk of clinically relevant PHLF (grades B and C). Clinically relevant PHLF increased the risk of 90-day mortality and was associated with impaired long-term survival. ISGLS grade A had more major postoperative complications compared with no PHLF but failed to be an independent predictor of both 90-day mortality and long-term survival. The impact of PHLF grade B/C on long-term survival was no longer present in patients surviving the first 90 days after surgery.ConclusionsThe presently used ISGLS definition for PHLF should be reconsidered regarding mortality as only PHLF grade B/C was associated with a negative impact on short-term survival; however, even ISGLS grade A had clinical implications.

EFFICIENCY PORTAL VEIN X-RAY VASCULAR EMBOLIZATION IN EXTENDED HEPATIC RESECTION

Relevance. To evaluate the effectiveness of X-ray endovascular embolization of the portal vein branch in terms of preparation for extensive liver resections. Materials and methods. A retrospective analysis of 74 right-sided hemihepatectomies performed in one stage (classical, n = 54) or in two stages (X-ray endovascular embolization of the right portal vein followed by liver resection was performed, n = 20).Results. X-ray endovascular embolization of the right portal vein was accompanied by a significant increase in the planned liver remainder by an average of 37.3 %. This made it possible to reduce the volume of intraoperative blood loss, the incidence of postresection hepatic failure from 43.1 to 15.9 %, and postoperative mortality from 9.3 to 5.0 %.Conclusions. Preoperative X-ray endovascular embolization of the right portal vein leads to vicarious enlargement of the left lobe of the liver. This makes it possible to reliably reduce the incidence of post-resection hepatic failure after right-sided hemihepatectomy and, accordingly, reduce the frequency of deaths.

Simultaneous surgical treatment of hepatocellular carcinoma with tumor thrombus in the inferior vena cava and ischemic heart disease own research and literature review.

<b> Introduction:</b> Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related death worldwide. Tumor penetration into the inferior vena cava/right atrium is rare, as it occurs only in 34% of HCC patients. There are no clear guidelines for the management of this stage of disease. </br></br> <b>Aim:</b> This is a case report of a patient with HCC and tumor thrombus in the inferior vena cava and with advanced coronary artery disease. </br></br> <b> Materials and methods:</b> The patient was qualified for a simultaneous cardiac surgery and liver resection with removal of the tumor thrombus from the inferior vena cava due to a high risk of sudden cardiac death. The first stage involved aortocoronary bypass followed by a right-sided hemihepatectomy with removal of the tumor thrombus from the inferior vena cava (this part of the operation was performed by extracorporeal circulation). The postoperative period was uneventful. Surgical treatment is one of the therapeutic options that offers a chance to radically remove the tumor and extend the patient's life. From a standpoint, these operations are extremely difficult and carry a high risk of perioperative complications (up to 40%). At the same time, the patient is at risk of complications due to cancer, such as pulmonary embolism, tricuspid stenosis, and congestive heart failure, which should be considered when choosing a treatment method. A significant number of patients also suffer from chronic conditions that worsen the prognosis. Cardiac diseases combined with tumor thrombus in the inferior vena cava may cause sudden cardiac death. </br></br> <b>Conclusions:</b> Surgical treatment should be considered in patients with HCC and tumor thrombus in the inferior vena cava, especially in patients with cardiovascular disease burden, as it is not only a chance to prolong life, but also to protect them against life-threatening cardiac complications.

Analysis of surgical treatment of liver hemangiomas

Objective. Development of criteria for optimal tactics of surgical treatment of liver hemangiomas of various sizes and localizations.
 Materials and methods. A retrospective analysis of 247 patients with hepatic hemangiomas observed on an outpatient basis and in a hospital was carried out; 59 of them (23.89 %) were operated including 12 men and 47 women over the period of 19992019. Liver resection with hemangioma was performed in 30 patients, hemangioma enucleation in 21, X-ray endovascular occlusion in 8 patients. The diagnosis was established on the basis of ultrasound of the abdominal organs, CT and MRI with contrast as well as angiographic research methods.
 Results. The postoperative complications developed in 4 (6.78 %) cases: reactive pleurisy was detected in 2 patients after the right-sided hemihepatectomy, hematomas in the resection zone of segments of the right lobe of the liver with a tumor were diagnosed in 2 patients. All complications were eliminated by conservative measures. There were no lethal outcomes.
 Conclusions. Surgical treatment of patients with hemangiomas includes resection of the liver with a tumor, enucleation of the hemangioma, and various types of local destruction. In order to reduce the blood circulation of the tumor and decrease the risk of intraoperative blood loss, the ECA of the branches of the hepatic artery was indicated. A comparative analysis of the results of treatment of patients with liver hemangiomas using various methods of surgical interventions made it possible to develop optimal surgical tactics, a system of intra- and perioperative safety in this category of patients.

Causes, diagnosis, and treatment of postoperative obstructive jaundice

AIM: This study aimed to analyze the causes, diagnosis, and clinical treatment of postoperative obstructive jaundice (POOJ) in routine surgical practice.
 MATERIALS AND METHODS: Twenty-four patients with POOJ that developed in the organs of the hepatobiliary system after surgical interventions were included in this study. The patients were subjected to the following procedures to diagnose the causes of POOJ and choose the treatment methods: general clinical examination, biochemical blood tests, dynamic postoperative ultrasound examination of the abdominal organs, video laparoscopy, computed tomography, magnetic resonance imaging, fistulocholangiography, endoscopic retrograde cholagiopancreatography, and percutaneous transhepatic cholangiostomy.
 RESULTS: POOJ occurred in 18 cases after they had different variants of surgical interventions on the biliary tract after traditional (n = 6) and video laparoscopic cholecystectomy (n = 12). POOJ also developed in 6 cases after they underwent surgery on the liver: atypical (n = 2) and anatomical (n = 2) resection of the liver. This condition manifested after the opening and draining of liver abscesses under US control (n = 2). POOJ was treated with different methods to alleviate the developed complications. After surgical interventions on the liver and biliary tract in 6 cases, relaparotomy, sequestrectomy with sanation, drainage of the abdominal cavity (n = 4), and right-sided hemihepatectomy (n = 2) were performed. In 6 other cases, on days 34 of the development of POOJ after laparoscopic operation (n = 2), relaparotomy was performed, clips and ligature were removed from the choledoch with the formation of Roux-en-Y hepaticojejunostomy. Minimally invasive methods of POOJ correction were applied to 12 cases. Of the 12 cases, 5, 2, and 1 were subjected to endoscopic papillosphincterotomy with lithoextraction, endoscopic papillosphincterotomy with lithoextraction coupled with nasobiliary drainage, and relaparoscopy and redrainage of the common bile duct, respectively. In 4 cases, percutaneous transhepatic cholangiostomy was performed at the first stage. At the second stage, after POOJ resolution, the following procedures were implemented: redrainage of the common bile duct (n = 2) and dilatation of the orifice of the right hepatic duct with reconstruction of hepaticojejunostomy on the hidden transhepatic drainage.
 CONCLUSION: POOJ is still encountered in clinical practice in a sufficient number of cases. Treatment results largely depend on the time of diagnosis and the choice of optimal surgical strategies. The main causes of POOJ are tactical and technical diagnostic and treatment errors. POOJ is diagnosed on the basis of the data of modern radiation and laboratory and instrumental examination methods. Surgical tactics for POOJ are individually active and dependent on the severity, time, and causes of development. They also depend on the general condition of patients. Along with minimally invasive interventions for POOJ, early relaparotomy is less dangerous than passive expectation tactics.

Extended Right-hemihepatectomy Is Preferred for Perihilar Cholangiocarcinoma.

Extended Right-hemihepatectomy Is Preferred for Perihilar Cholangiocarcinoma.

Treatment of children with very low-risk hepatoblastoma according to the Children’s Hepatic tumors International Collaboration classification: a series of clinical observations

Relevance. The success of treatment of children with hepatoblastoma (HB) is associated primarily with the optimization of diagnostic and therapeutic strategies. The introduction of a system of therapeutic definition of a risk group developed by the International Society for the Study of Liver Tumors in Children’s Hepatic tumors International Collaboration (CHIC) in patients with HB allows for effective risk stratification. Patients of the very low-risk group have a favorable prognosis and, unlike patients of other groups, they can perform surgery at the 1st stage, and children from the very low-risk group with a “pure” fetal version of the morphological structure of the tumor can be cured without chemotherapy – only by surgical method. This article presents an analysis of a series of observations of children with HB very low-risk.Methods and patients. A retrospective analysis of the data of 138 patients who received treatment at the Research Institute of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Centre of Oncology of the Ministry of Health of Russia from January 2006 to February 2018, all patients underwent examination in the following volume: computed tomography (CT) of the chest, ultrasound of the abdominal cavity and retroperitoneal space, CT and/or magnetic resonance imaging of the abdominal cavity with contrast enhancement. Serum levels of human chorionic gonadotropin and alpha-fetoprotein (AFP) were measured. The prevalence of tumor lesions was retrospectively evaluated using the PRETEXT system (Pre-Treatment Extent of Disease, assessment of the prevalence of the tumor process before treatment, 2017 version). Based on the data obtained, 18 (13 %) patients with hypertension were identified in the very low-risk group using the CHIC stratification system. Of 18 (100 %) patients of the very low-risk group, 8 (44.4 %) received therapy in the interval from January 2006 to October 2010 according to the treatment protocols of the SIOPEL group. The treatment included a combination of neoadjuvant chemotherapy with delayed surgery and adjuvant chemotherapy. Since November 2010, the Research Institute of Pediatric Oncology and Hematology adopted a protocol for the treatment of children with hypertension, suggesting the possibility of performing surgical treatment at the 1 st stage in patients with a localized stage of the disease with the spread of PRETEXT I/II. From December 2010 to November 2018, 10 (55.6 %) patients from the very low-risk group were operated on at the 1 st stage. A tumor biopsy was not performed before the intervention. After a histological examination, 4 (22.2 %) patients had an epithelial variant of the structure of HB that did not meet the criteria of a “pure” fetal variant. He was given adjuvant chemotherapy according to the SIOPEL protocol. And in 6 (33.3 %) patients, according to the results of a morphological study, the HB structure variant was interpreted as a “pure” fetal variant. Further therapy in this group of patients was not performed. The analysis of the results of treatment of these 6 patients without the use of chemotherapy is presented in our article.Results. The average age of patients is 3.7 (1–6) years, the median is 3.7 ± 2.0. Boys/girls – 4:2. In all cases, there was an asymptomatic course of the disease, a neoplasm was detected by chance during an ultrasound scan. All children had an elevated AFP level in the range of 95.2–695 (286.0 ± 116.8) IU/ml. Distribution according to PRETEXT I/II – 2 (33.3 %) and 4 (66.7 %) patients, respectively. Patients did not have additional PRETEXT criteria and metastases. Surgical treatment was performed by the laparoscopic method in 2 of 6 patients. Scope of operation: right-sided hemihepatectomy – 3, left-sided – 1, bisegmentectomy – 1, atypical resection – 1. Lymphatic dissection in the area of the hepatoduodenal ligament was not performed. There were no complications of treatment and repeated surgical interventions. The radicalness of the intervention in the volume of R0 was confirmed by histological examination in all patients. Morphological examination in all cases revealed a “pure” fetal version of the structure of the tumor. All patients are alive without signs of relapse at follow-up periods of 14.7 to 59.2 (32.0 ± 18.7) months.Conclusion. Using the system of therapeutic stratification into risk groups CHIC allows you to effectively distinguish patients with very low-risk groups, and for some children with a “pure” fetal version of the histological structure of the tumor, only the surgical approach can be used for treatment. At the same time, the short observation period for the patients and their small number do not allow us to draw final conclusions and dictate the need for a multicenter study. It should be noted that this cohort of patients requires careful observance of the post-therapeutic observation algorithm.

Spontaneous liver rupture in a pregnant woman associated with HELLP syndrome

Spontaneous liver rupture is rare and highly dangerous, life-threatening condition occurring in 1–2% of pregnant women with preeclampsia and eclampsia. There are more than 100 similar case reports in the literature. It is believed that liver rupture is caused by HELLP syndrome as one of the signs of preeclampsia. The results of surgical treatment is still unsatisfactory. Appropriate treatment strategy is absent because of rareness of this condition. It is presented case report of a woman with spontaneous liver rupture associated with HELLP syndrome. Patient underwent perihepatic tamponade, endovascular embolization of right hepatic artery followed by right-sided hemihepatectomy.

Assessment of results of a resection of a liver

Background: The lethality after a resection of a liver remains within 4 – 6% and is very far from zero. Objective: to assess the immediate results of liver resection. Methods: Objective: to assess the immediate results of liver resection. Material and methods: For the 2012-2015 operated on 72 patients about various diseases of the liver require the removal of 3 or more segments. Men – 43 women – 29. Age from 41 to 79 years. On average, 58±6 years. Malignant diseases – 55; benign – 17 patients. Performed a right-sided hemihepatectomy – 36 (including, with resection and reconstruction of blood vessels – 2), left hand – 32(including resection of the vessel – 1, resection of the stomach – 1); Resection of IV-V-VIII segments – 4 patients. Severe comorbidities were – 17 patients. Two patients were 9 and after 11 courses of chimiotherapie respectively. Severe fibrosis and liver steatosis had 21 patients. Operative intervention – 210 min Occlusion hepatoduodenal ligament in 60 patients. The average blood loss – 200,0 ±110,0 ml. Results: Results: Complications after surgery and 23(31.9 percent). Acute liver failure – 1 (1); postoperative bleeding 1(1), sepsis – 1(1). Non-specific complications had 18 patients and specific five, three of whom died. Conclusion: Conclusion: the complication and mortality rate after resection remains high. An increasing number of elderly patients requiring liver resection. To prevent severe postoperative complications must be strict adherence to anatomic principles of resection.

Selection of the resection volume of the liver in patients with Klatskin tumor

The objective of the study was to determine the possibilities of surgical treatment and to evaluate the criteria for selecting the resection volume of the liver in patients with Klatskin tumor.Material and methods. From 2005 to 2018, 36 patients with Klatskin tumor aged from 30 to 74 years were operated in the Department of surgery of «Russian scientific center of radiology and surgical technologies n.a. acad. A. M. Granov». Radical surgical interventions (R0) were performed in 28 (77.7 %) patients. 7 (19.5 %) patients underwent palliative surgery.Results. Selection of the resection volume of the liver and bile duct was carried out on the basis of assessment of the functional state, morphological changes in the liver and results of urgent intraoperative histological examination. As a radical intervention for IIIa, IIIb and IV types of Klatskin tumor (93.1 % of patients), extensive liver resection (left-sided or right-sided hemihepatectomy) with biliary and, in the presence of invasion into the main vessels, with vascular reconstruction was performed.Сonclusion. Timely and adequate liver resection with biliary reconstruction is a radical surgical intervention for Klatskin tumors. Selection of the resection volume of the liver, especially for type IV tumors, is determined by the morphological changes and the reserve capacity of the liver. The status of the resection edge is crucial for the selection of subsequent treatment tactics. Combination of methods of regional chemoinfusion and intraductal photodynamic therapy is necessary after non-radical intervention.

Role of preoperative x-ray endovascular interventions for improvement of resectability of colorectal liver metastases

The objective was of the study to evaluate the role of preoperative x-ray endovascular interventions – transcatheter arterial chemoembolization (TACE) and portal vein embolization (PVE) – for improvement of resectability of colorectal liver metastases.Material and methods. Between 1997 and 2017, we treated 11 patients who simultaneously had large-volume (60–70 %) of right liver lobe colorectal metastases and small future remnant liver. The treatment was started from 1–4 cycles of TACE to reduce or stabilize the rapid growth of the tumor. In case of good effect, we performed PVE and then we performed liver resection.Results. There were no major complications of TACE or PVE. After 1–4 cycles of TACE, the volume of metastases showed partial decrease or stabilization. The following PVE allowed to increase the future remnant volume of the left liver lobe up to a safe 40–45 %. Right – sided hemihepatectomy was performed in 6 patients and extended right-sided hemihepatectomy in 5 patients. There were no postoperative mortality or severe complications. At present, 4 patients are alive without recurrence during 1.5–8 years, and 4 other patients received endovascular treatment for local recurrence are alive during 1.5–5 years. The 3 patients died from tumor progression during 13–30 months. CONCLUSION. In patients with simultaneously extensive for resection volume of right liver lobe metastases and small left liver lobe, the primary treatment with TACE is reasonable. Only after the documentation of tumor decrease or stabilization, it is necessary to determine the timing of PVE and following major liver resection. This order of treatment procedures allows to improve resectability in cases with extensive, large-volume, rapidly grown malignant liver lesions.

Single photon emission computed tomography (SPECT) for planning of surgical tactics in advanced liver resections

Aim. To determine the indications for staged treatment in planning of advanced liver resections using SPECT. Material and methods. There were 26 patients for the period 2007–2016 who required advanced liver resections at the surgical clinic of the Botkin Hospital. Anatomic FLR (aFLR) was less than 30% in all cases that is an indication for right portal branch embolization. Two-stage treatment has been applied in 15 patients (group 1) for the period 2007–2014. Preoperative examination has included SPECT since 2015. Indication for two-stage treatment was functioning FLR (fFLR) less than 30% (group 2). The second group included 11 patients. Results. In the first group (n = 15), all patients underwent right portal branch embolization. Nine of them underwent surgery including advanced right-sided hemihepatectomy in 5 cases and right-sided hemihepatectomy in 4 cases.Acute postoperative liver failure occurred in 1 (11.1%) patient (ISGLS class A). In the second group (n = 11) need for portal embolization was determined after SPECT. In 5 patients fFLR was over 30%. Thus, advanced right-sided hemihepatectomy and conventional right-sided hemihepatectomy were carried out in 2 and 3 cases, respectively. Six patients had fFLR less than 30% and two-stage approach was indicated. Five patients underwent radical surgery: advanced right-sided hemihepatectomy and conventional right-sided hemihepatectomy were carried out in 2 and 3 cases, respectively. There were no cases of acute postoperative liver failure and mortality in this group. Conclusion. Preoperative SPECT is able to predict high risk of acute postoperative liver failure after advanced liver resection. Therefore, certain measures for prevention of this complication may be considered.

Results of Surgical Treatment of Patients with Liver Alveolar Echinococcosis

Aim . To evaluate surgical outcomes in patients with liver alveococcosis. Material and Methods. 581 patients have been included for the period 2000–2016. There were 366 (62.9%) women and 215 (37.1%) men. Mean age was 35.0 ± 1.5 years. Right liver lobe lesion was observed in 380 (65.4%) cases, left lobe involvement – in 140 (24.1%) cases, both lobes lesion – in 61 (10.5%) patients. 8 patients had lungs metastases, 3 – brain metastases, 1 – metastases in right ventricle and lungs. One patient had a rare coinfection of alveococcosis with echinococcosis. 570 patients underwent surgery. Results. Radical surgery was performed in 424 (74.3%) cases, palliative procedures – in 146 (25.5%) patients. 163 (28.1%) patients underwent right-sided hemihepatectomy including tangential inferior vena cava resection in 3 patients. Advanced right- sided hemihepatectomy was carried out in 36 (6.2%) cases including 2 cases of concomitant tangential resection of inferior vena cava and 4 cases of common bile duct resection followed by hepaticojejunostomy. Left-sided hemihepatectomy was made in 95 (16.4%) patients, 2 of them underwent concomitant tangential resection of inferior vena cava. Advanced left-sided hemihepatectomy was performed in 22 (3.6%) cases including tangential resection of portal vein in 1 patient and common bile duct resection followed by hepaticojejunostomy in 1 patient. Atypical or anatomic liver resection (segmentectomy, double segmentectomy, triple segmentectomy) was made in 64 (11.1%) patients. Hemihepatectomy followed by resection of the other lobe was carried out in 44 (7.5%) cases. Percutaneous transhepatic cholangiostomy was made in 28 (4,8%) cases, explorative laparotomy – in 25 (4.3%) patients. Transhepatic drainage of bile ducts was performed in 42 (7.2%) cases, cytoreductive procedures – in 51 (8.8%) cases. Postoperative morbidity rate was 9.8% (n = 56), mortality – 2.1% (n = 12). Conclusion. Radical surgery for liver alveococcosis is difficult but provides positive results in timely diagnosis. Proportion of radical procedures is much greater in case of early diagnosis of the disease. Palliative surgery combined with chemotherapy with albendazole is justified to improve quality of life.

COMBINED RESECTION OF THE LIVER AND THE INFERIOR VENA CAVA IN HEPATOCELLULAR CARCINOMA

It is presented clinical observation of the patient living over 8 years after extended right-sided hemihepatectomy with resection and replacement of the inferior vena cava for locally advanced hepatocellular carcinoma. The authors emphasize the need for only aggressive surgical approach to achieve satisfactory long-term outcomes in these patients. The possibilities of transplantation techniques in particular complete vascular isolation of the liver and temporary veno- venous bypass are discussed.