Aim. To justify the necessity of combined intraportal administration of mononuclear stem cells, transjugular intrahepatic portosystemic shunting, and partial splenic embolization in patients with portal hypertension and hepatocellular insufficiency against the background of liver cirrhosis, to develop a technology, and to evaluate its safety and efficacy.

Materials and methods. The study involved the results of treatment for 1631 patients with liver cirrhosis of various etiologies from 2018 to 2023; 272 patients (16.7%) were included in the waiting list for cadaveric liver transplantation. During the waiting period, 195 patients (71.6%) underwent some method of surgical correction for portal hypertension: 84 patients (43.1%) underwent endoscopic ligation of esophageal varices, 46 patients (23.6%) had transjugular intrahepatic portosystemic shunting, 21 patients (10.7%) received partial splenic embolization, and 35 patients (17.9%) underwent both transjugular intrahepatic portosystemic shunting and partial splenic embolization in one procedure. In 15 cases (5.5%), intraportal administration of autologous bone marrow mononuclear cells was performed. In 9 cases (4.7%), this technology was combined with minimally invasive methods for correcting portal hypertension: in 6 cases (3.1%) with transjugular intrahepatic portosystemic shunting and in 3 cases (1.6%) with both transjugular intrahepatic portosystemic shunting and partial splenic embolization.

Results. Following the intraportal administration of autologous bone marrow mononuclear cells and minimally invasive surgical techniques for correcting complications of portal hypertension, no surgical complications or adverse events were observed. The average follow-up period for patients was 9 (3;15) months, with a MELD score during dynamic observation of 16 (12;18) points. No progression of complications related to portal hypertension was noted.

Conclusion. The combination of intraportal administration of autologous bone marrow mononuclear cells with minimally invasive methods for correcting complications of portal hypertension represents a promising, effective, and safe strategy for reducing mortality in patients awaiting cadaveric liver transplantation and improving treatment outcomes for patients with terminal diffuse liver diseases.

Aim. To develop and justify a new criterion for selecting patients for liver transplantation in cases of hepatocellular carcinoma against the background of cirrhosis in order to improve the accuracy of recurrence prediction and ensure clinically acceptable five-year disease-free and overall survival rates.

Materials and methods. A retrospective analysis was conducted on the results of liver transplantation in 69 patients with cirrhotic hepatocellular carcinoma. The size of the largest tumor, the number of tumors, alpha-fetoprotein level and the maximum LI-RADS score were considered to determine the new selection criteria for patients. New criteria termed “5-6-250/LI-RADS” were developed and compared with regard to their effectiveness with the Milan criteria and the 5-5-500 rule. Sensitivity, specificity, F1-score, C-index, and overall and disease-free survival were calculated.

Results. The proportion of patients meeting the criteria of 5-6-250/LI-RADS, 5-5-500, and the Milan criteria accounted for 65.2%, 60.9%, and 36.2%, respectively. The sensitivity, specificity, C-index, and F1-score for the 5-6-250/LI-RADS were found to be 78%, 100%, 0.89, and 0.87; for the 5-5-500 rule – 78%, 88%, 0.83, and 0.82; for the Milan criteria – 89%, 65%, 0.77, and 0.79, respectively. The five-year disease-free survival rates amounted to 85%, 86%, and 91%, and the five-year overall survival rates accounted for 76%, 79%, and 78%.

Conclusion. The study confirmed the potential of the 5-6-250/LI-RADS rule in enhancing patient selection for liver transplantation in cases of hepatocellular carcinoma. The integration of LI-RADS with traditional parameters demonstrated high sensitivity, specificity, F1-score, and C-index values. This contributes to a more accurate assessment of recurrence risk and expands indications for transplantation. The accuracy and automation of the LI-RADS classification can be improved through increasing the sample, applying machine learning methods, and validation on real data.

Aim. To study the pathological histological subtypes of intrahepatic cholangiocarcinoma and their impact on survival.

Materials and methods. The study involved the analysis of perioperative data from 65 patients with intrahepatic cholangiocarcinoma. Among them, 32 patients (49%) were found to have the small bile duct subtype, while 33 patients (51%) were diagnosed with the large bile duct subtype.

Results. The histopathological subtype of intrahepatic cholangiocarcinoma originating from large bile ducts is considered to be a significant factor affecting overall survival (p < 0.0001) and disease-free survival (p =0.0074).

Conclusion. In clinical practice, assessing the small and large duct subtypes of intrahepatic cholangiocarcinoma is claimed to be essential for stratifying risk factors affecting disease prognosis.

Aim. To study the structural changes in liver tissue resulting from stenting, the dependence of these structural changes on the duration of stenting of the common bile duct, and the incidence of obstructive jaundice.

Materials and methods. The study groups consisted of 45 patients with choledocholithiasis. Group 1 included 13 patients who experienced cholangitis 1–2 times, while Group 2 comprised 32 patients with recurrent cholangitis occurring more than twice, necessitating multiple stenting of the common bile duct.

Results. The duration and frequency of stenting of the common bile duct, as well as the recurrence of cholangitis, lead to hyperplasia of the bile ducts up to severe hepatocellular disease with the formation of portocaval septa and severe cholangiohepatitis, accompanied by loss of functional capacity. Multiple stenting in choledocholithiasis, in the absence of somatic diseases that hinder radical treatment, is considered inadmissible. Due to structural complications, re-stenting should only be performed based on strict life indications.

Conclusion. Complex choledocholithiasis should be maximally resolved during repeated hospitalization – either endoscopically or surgically – within a timeframe of 3 to 6 weeks after amelioration of the clinical picture of obstructive jaundice and normalization of laboratory parameters.

Aim. To investigate the effect of perfluoroorganic compounds and poloxamer 188 on liver regeneration and the severity of systemic inflammatory response in an experimental model of sepsis.

Materials and methods. Sepsis was induced in 52 male Wistar rats. Rats in experimental group 1 (n = 16) received a single intravenous injection of Oxiftem, rats in experimental group 2 (n = 15) were injected with Myotiv, and rats in the control group (n = 21) received a 0.9% NaCl solution. An intact group of rats (n = 11) was not subjected to sepsis modeling and received no treatment. Daily observations were conducted for 14 days. On the 15th day, rats were euthanized under light ether anesthesia. Biochemical serum parameters and the results of histological examination of liver tissue with immunohistochemical assessment of CD68 expression were studied.

Results. No abnormalities were observed in the liver parenchyma of the intact group of rats. In the liver of the control group during sepsis, structural alterations of hepatic plates, perinuclear edema of hepatocytes, fatty degeneration of the liver, and congestion of portal tract vessels were noted, indicating morphological manifestations of liver necrosis, as well as proliferation of bile ducts, which is a histological consequence of cholestasis. In the experimental group, preservation of hepatic plate structure, an increase in the total number of nuclei, and binucleated hepatocytes were observed; sinusoids were not dilated. Hepatocyte proliferation and an increase in the number of binucleated liver cells indicated a regenerative response to systemic inflammatory damage and metabolic demand. A reduction in CD68-positive cell content in the liver following administration of both perfluoroorganic compounds and poloxamer 188 may be attributed to the suppression of macrophage activity and phagocytosis. This indicates a blockade of the immune functions of Kupffer cells in the experimental model of sepsis.

Conclusion. The application of perfluoroorganic compounds and poloxamer 188 enhances liver regeneration and reduces the amplitude of systemic inflammatory response reactions in an experimental model of sepsis.

Aim. To investigate the immediate outcomes of multivisceral surgeries with pancreaticoduodenectomy for tumors of various localizations.

Materials and methods. From January 2011 to April 2024, 251 patients underwent multivisceral surgery with pancreaticoduodenectomy for tumors of different localizations. The control group consisted of 832 patients who underwent standard pancreaticoduodenectomy. Intergroup and intragroup comparative analyses were performed.

Results. In the main group, postoperative complications developed in 165 patients (65.7%), with complications classified as ≥3 (severe complications) according to the Clavien-Dindo classification occurring in 97 patients (38.6%). 18 patients (7.2%) died postoperatively. In the control group, severe postoperative complications were recorded in 36.6% of patients, and 49 patients (5.9%) died. Risk factors for postoperative complications classified as ≥3 included obesity (p = 0.026), ischemic heart disease (p = 0.033), postinfarction cardiosclerosis (p = 0.008), combination with hemigastrectomy (p = 0.031), small diameter of the pancreatic duct (p < 0.001), and soft pancreas (p < 0.001). Significant risk factors for postoperative mortality included diabetes mellitus (p = 0.002), colon resection (p = 0.002), and density of the pancreatic stump (p = 0.012).

Conclusion. Multivisceral surgeries with pancreaticoduodenectomy vary in the number of resected and excised organs, are accompanied by an incidence of postoperative complications classified as ≥3 according to Clavien–Dindo (38.6%) and a mortality rate (7.2%) comparable to that in the control group. Overall, the tolerability of these complex and traumatic surgical interventions by patients is found to be acceptable, provided they are performed only in specialized institutions.

Aim. To analyze current literature sources on gallbladder cancer and to study the long-term outcomes of treatment for this disease.

Materials and methods. The study involved a retrospective analysis of the treatment results of 33 patients with histologically confirmed gallbladder cancer.

Results. At the preoperative stage, the diagnosis of gallbladder cancer was established in 19 patients (58%), while 11 cases (33%) were diagnosed with portal cholangiocarcinoma, cholangiocellular carcinoma, and hepatocellular carcinoma. Malignant neoplasms were diagnosed in 30 cases (91%) prior to surgery. Resectional procedures were performed in 21 patients (64%), with R0 resection achieved in 7 cases (21%) and R1 surgery performed in 11 patients (33%). The average duration of hospital stay after surgery amounted to 15.6 (1–71) days. The median survival time accounted for 10.5 months.

Conclusion. The detection and treatment of gallbladder cancer are associated with considerable challenges. Ensuring early and accurate diagnosis and radical surgical intervention stands as a primary aspect to develop. Given the aggressive nature of the tumor, research into the biological characteristics of this type of cancer may hold significant potential.

Aim. To evaluate the treatment outcomes for patients with true type IV portal cholangiocarcinoma according to the Bismuth–Corlette classification.

Materials and methods. The study involved the treatment outcomes of 272 patients with portal cholangiocarcinoma for 2014–2022. Bismuth–Corlette type IV tumors were initially diagnosed in 59 patients.

Results. Upon assessing the anatomy of bile duct confluence using MRI and cholangiography, Bismuth–Corlette type IV tumors were verified in only 22 patients. In other cases, the extent of the tumor process was overestimated due to different anatomical configurations of the duct confluence. Seven patients (33%) underwent surgery, with R0 resection performed in four of them. The median survival after radical surgery accounted for 12 months (8–23 months), while in the palliative group without chemotherapy, it amounted to 3 months (2–12 months), and with chemotherapy – 10 months (3–34 months).

Conclusion. Radical surgical intervention can be performed in one-third of patients with proven Bismuth–Corlette type IV portal cholangiocarcinoma. A comprehensive multidisciplinary approach to treatment enhances the survival duration of palliative patients with portal cholangiocarcinoma.

Aims: Gastrointestinal and pancreatobiliary neuroendocrine tumors (GNETs) are rare malignancies, with gallbladder neuroendocrine neoplasms (GB-NENs) representing less than 0.5% of all NETs. This study aims to describe the clinical features, management strategies, and outcomes of gallbladder neuroendocrine neoplasms treated within the West Algerian NET Network.

Materials and Methods. A retrospective analysis was conducted on 9 cases of gallbladder neuroendocrine neoplasms diagnosed between December 2015 and September 2024 from a total of 301 patients with Gastrointestinal and pancreatobiliary neuroendocrine tumors. Data were collected on age, sex, clinical findings, tumor grade, Ki-67 levels, stage, management, and survival outcomes.

Results. Among the 9 patients (6 females, 3 males; mean age: 58.56 years), 4 had well-differentiated NETs, and 5 had large cell neuroendocrine carcinomas. Common clinical presentations included right hypochondrial pain (100%), jaundice (22%), palpable mass (33%), and weight loss (56%). Surgical resection was performed in 3 cases, achieving R0 resection with negative margins. The overall survival was 8.7 months, with those undergoing curative surgery surviving a mean of 17.7 months compared to 4.2 months for non-surgical patients. Jaundice at diagnosis was significantly associated with poorer survival (mean survival: 2.5 months vs. 10.4 months without jaundice.

Conclusion. Gallbladder neuroendocrine neoplasms are rare tumors that present unique clinical challenges. This case series highlights the importance of early diagnosis and aggressive management, with jaundice at presentation serving as a critical prognostic factor. Surgical resection appears to offer potential survival benefits, though further studies are needed to refine management strategies for these rare neoplasms.