Aim. To validate the national model of the textbook outcome and modified textbook outcome when comparing shortterm outcomes of laparoscopic and open liver resections for colorectal liver metastases.

Material and Methods. A retrospective analysis was conducted on patients operated on between June 2017 and January 2020 in two specialized centers in Russia. Indicators of achieving the textbook outcome and modified textbook outcome, along with factors influencing their attainment were considered. The 75th percentile of the length of hospital stay was used as the modifier for the modified textbook outcome.

Results. Out of 171 cases who underwent surgery, 96 patients were treated in Center No. 1 and 75 in Center No. 2. A total of 85 open liver resections and 86 laparoscopic liver resections were performed. In Center No. 1, open and laparoscopic resections were performed in 47 (49%) and 49 (51%) patients, respectively; in Center No. 2, in 43 (57%) and 32 (43%) patients, respectively. The textbook outcome was achieved in 118 patients (69%), with 73 (76%) in Center No. 1 and 45 (60%) in Center No. 2 (p = 0.024).

Conclusions. The textbook outcome and modified textbook outcome models are suitable for clinical practice and can be used to compare liver resection results. Incorporating the 75th percentile of hospital stay into the modified textbook outcome reduces bias from non-clinical factors when evaluating treatment duration.

Aim. To conduct a meta-analysis of studies comparing parenchyma-sparing and anatomical liver resections.

Material and Methods. A search was performed in PubMed, Web of Science, Scopus, Embase, and the Cochrane Library for studies published up to 31 December 2024 that compared parenchyma-sparing and anatomical resections for colorectal liver metastases.

Results. The analysis included retrospective studies (21 publications). Parenchyma-sparing resections were associated with shorter operative duration (WMD –39.11; 95% CI [–64.73, –13.49]; p = 0.003), lower blood loss (WMD –278.86; 95% CI [–465.88, –91.83]; p = 0.003), and shorter hospital stay (WMD –1.81; 95% CI [–2.96, –0.67]; p = 0.002). The overall incidence of postoperative complications did not differ significantly. Postoperative mortality (OR 0.29; 95% CI [0.18, 0.46]; p < 0.00001), postoperative liver failure (OR 0.17; 95% CI [0.07, 0.38]; p = 0.00001), and postoperative transfusion rates (OR 0.40; 95% CI [0.22, 0.75]; p = 0.004) were higher after anatomical resections. Overall survival (HR 1.07; 95% CI [0.97, 1.17]; p = 0.2) and recurrence-free survival (HR 1.09; 95% CI [0.98, 1.21]; p = 0.11) did not differ significantly. Recurrence rates (OR 1.41; 95% CI [0.94, 2.10]; p = 0.10) and positive resection margins (OR 1.39; 95% CI [0.97, 1.99]; p = 0.07) also showed no statistically significant differences.
Conclusion. The analysis demonstrates advantages in short-term outcomes for parenchyma-sparing resections compared with anatomical resections, while long-term outcomes remain comparable.

Aim. To assess the effectiveness and feasibility of CT radiomics-based machine-learning models for hepatocellular carcinoma diagnosis.

Materials and Methods. The study included 42 patients with pathologically confirmed hepatocellular carcinoma. All patients underwent surgery or received medical advice between January 2013 and December 2022. Machinelearning algorithms were used to evaluate texture analysis data from preoperative CT scans.

Results. In comparative analysis, the AdaBoost model outperformed standard statistical methods in identifying Grade 3 hepatocellular carcinoma. Sensitivity was higher by 15.4%, specificity by 3.1%, and diagnostic accuracy by 15.31%.

Conclusion. The use of machine-learning based radiomics is a promising noninvasive method for evaluating the histological hepatocellular carcinoma grade. The obtained results may be applied in a variety of clinical and research contexts.

Aim. To develop a non-invasive, accurate, and simple method for determining portal vein pressure in patients with cirrhosis-related portal hypertension.

Materials and Methods. In 72 patients with complicated portal hypertension, the relationship between portal pressure and liver and spleen stiffness was examined. Exact portal vein pressure was  obtained by direct manometry during TIPS. Liver and spleen stiffness were measured using elastometry. The number of spontaneous portosystemic shunts detected on CT was also taken into account.

Results. A direct relationship was identified between the severity of portal hypertension and the values of liver and spleen elastometry, adjusted for the number of spontaneous portosystemic shunts detected on CT splenoportography. This enabled derivation of a simplified formula for calculating elevated portal vein pressure. The error of method was slightly above 5% compared with direct portomanometry.

Conclusion. The proposed non-invasive method is accurate, easy to perform, and suitable for clinical use.

Aim. To analyze the outcomes of minimally invasive management of biliobiliary anastomotic cicatricial strictures after orthotopic liver transplantation.

Materials and Methods. From 2018 to 2024, a total of 234 orthotopic liver transplants from deceased donors were performed. To prevent biliary complications, intraoperative indocyanine green fluorescence imaging was used. In all cases of anastomotic stricture, ultrasound of the graft and MR cholangiopancreatography were conducted, and cholestatic biochemical markers were evaluated. All patients (n = 25) underwent minimally invasive endoscopic or percutaneous antegrade treatment.

Results. The endoscopic method achieved a technical success rate of 84%, and the antegrade method of 100%. There were no deaths. A management algorithm for biliobiliary anastomotic strictures following liver transplantation was developed from the findings. Plastic stent placement led to complications in 37.5% of cases and nitinol stent placement in 5.9% (p = 0.006). The clinical success rate of plastic stents was 37.5%, while nitinol stents achieved 100% (p = 0.009). However, the recurrence rate of anastomotic strictures after removal of plastic versus nitinol stents did not differ significantly (p = 0.2).

Conclusion. The most justified approach to biliobiliary anastomotic cicatricial strictures after orthotopic liver transplantation is temporary placement of a covered nitinol stent for 3 months. If signs of stricture persist after stent removal, repeated stenting for another three months is indicated. Intraoperative assessment of perfusion using indocyanine green fluorescence is considered a promising method for preventing biliary complications, as it enables timely identification of ischemic zones and reduces the risk of their development.

Aim. To evaluate antegrade biliary decompression as part of the multimodal treatment of patients with obstructive jaundice caused by colorectal cancer metastases.

Materials and Methods. The study included 85 patients (mean age 60.7 ± 11.7 years) with obstructive jaundice caused by metastatic colorectal cancer. The mean serum bilirubin level at admission was 297.99 ± 158.99 (35.1–785.2) µmol/L, and the duration of jaundice was 17.54 ± 13.43 (3–90) days, which precluded initiation or continuation of systemic therapy. Prior to the onset of jaundice, patients had received 1.36 ± 1.36 (0–5) lines of chemotherapy and 11.52 ± 12.10 (0–63) treatment cycles. All patients underwent antegrade biliary drainage: external (n = 7), external–internal suprapapillary (n = 60), or modified external drainage (n = 18).

Results. Clinical success of antegrade biliary decompression (reduction of bilirubin <40 µmol/L) was achieved in 48 patients (56%). Subsequent chemotherapy was administered to 29 patients (34.15%); 19 patients did not receive chemotherapy due to severe clinical condition. Complications occurred in 14.1% of cases, most commonly drain dislodgement. One-year survival among patients who received systemic anticancer therapy after decompression was 34% (n = 10), and 8.9% (n = 5) among those who did not. Age >66 years, bilirubin >400 µmol/L, and impaired hepatic protein synthesis function were statistically significant independent negative predictors of receiving systemic therapy after decompression. The associated risk ratios ranged from 41.7% to 100%.

Conclusion. Antegrade biliary drainage in its various modifications is an effective method of biliary decompression that enables initiation or continuation of systemic therapy in patients with colorectal cancer metastases. Decisions regarding the indication and type of drainage should be made by a multidisciplinary team using a multifactorial assessment of the condition and prognosis of patients.

We report a clinical case of a rare complication of gallstone disease in a pediatric patient – a choledochoduodenal fistula. A 9-year-old female had been treated conservatively for cholangitis. After transfer to our center, duodenoscopy revealed a choledochoduodenal fistula. Initially performed endoscopic sphincterotomy up to the level of the fistula and balloon lithoextraction resulted in resolution of biliary obstruction and cholangitis. Cholecystectomy did not follow because of marked inflammatory infiltration and a high risk of perioperative complications. However, the patient subsequently developed recurrent biliary colic successfully managed by emergency laparoscopic cholecystectomy. The study addresses diagnostic challenges and aspects of modern endoscopy, and provides a review of the relevant literature.

This case study reports the diagnostic and clinical features and offers management strategies for duodenal variceal bleeding in patients with portal hypertension. Particular attention is given to the potential development of ectopic varices in the duodenum, where bleeding is a highly dangerous and life-threatening complication. The report outlines available diagnostic tests used to identify the source of bleeding. The anatomical characteristics of duodenal varices and the high rate of bleeding recurrence are emphasized as special treatment challenges. The case described highlights the importance of early detection of duodenal varices and of comprehensive management of patients with portal hypertension and its complications of different severity.

This clinical case report provides a step-wise description of diagnostic evaluation and management of suspected hepatocellular carcinoma complicated by recurrent choledocholithiasis, suppurative cholangitis, and obstructive jaundice. The report focuses on the difficulty of early diagnosis as the tumor mimics inflammatory changes and the clinical presentation is not specific. The diagnostic role of alpha-fetoprotein and limitations of imaging modalities such as ultrasound and MRI are discussed. In addition to the diagnostic challenges of complicated hepatocellular carcinoma, the case highlights the importance of a multidisciplinary approach and includes a brief literature overview.