Aim. To improve the outcomes in patients with pancreatic head cancer using intraoperative radiotherapy (IORT).

Material and methods. Prospective trial included patients with ductal adenocarcinoma of the pancreatic head who underwent pancreatic surgery followed by IORT.

Results. There were 63 patients with pancreatic ductal adenocarcinoma for the period from January 2013 till December 2016. IORT was applied in 31 cases. Annual, 3-year survival and disease-free survival were analyzed.

Conclusion. Surgery followed by IORT is safe and current approach for pancreatic head cancer.

Aim. To analyze influence of perioperative intra-arterial selective chemotherapy on terms of recurrent ductal adenocarcinoma of pancreatic head after pancreaticoduodenectomy.

Material and methods. 111 patients underwent combined treatment. Surgical stage included conventional pylorussparing pancreaticoduodenectomy in all groups. The main group consisted of 52 patients who received combined treatment: neoadjuvant chemoembolization with gemcitabine (400 mg/m2) and oxaliplatin (50 mg/m2), surgical treatment and 6 courses of regional chemotherapy – infusion of gemcitabine (800 mg/m2) and oxaliplatin (45 mg/m2) into celiac trunk in adjuvant mode. The control group was presented by 59 patients who underwent perioperative regional chemotherapy (neoadjuvant chemoembolization and adjuvant infusion of gemcitabine (800 mg/m2). Progression-free survival (PFS) and terms of recurrence were analyzed in all groups. In case of progression and recurrence we applied regional chemotherapy alone. Systemic chemotherapy was not used in the study.

Results. Annual PFS in the main and the control groups was 80%. Three-year PFS in the main group was 37%, in the control group – 14% (p < 0.01). Five-year PFS was 11% in the main group and absent in the control group. Median survival was 26 months in the main group and 22.6 months in the control group. Overall annual, 2-year and 5-year survival in main group was 80%, 57% and 15%, respectively.

Conclusion. Regional intra-arterial chemotherapy decreases incidence of recurrences and improves PFS after surgical treatment of pancreatic head adenocarcinoma.Further multi-center studies are necessary to assess the effectiveness of regional chemotherapy.

Aim. To evaluate an effectiveness of non-invasive stimulation of gastrointestinal peristaltic activity in complex correction of motor-evacuation disorders and intra-abdominal hypertension in patients with severe acute pancreatitis.

Material and methods. There were 85 patients with severe acute pancreatitis. Patients were divided into two groups: group 1 (n = 43) – percutaneous resonance stimulation; group 2 (n = 42) – routine treatment of acute pancreatitis with intraperitoneal hypertension syndrome and dynamic intestinal obstruction according to normative documents. Intra-abdominal pressure was measured in 1, 3, 5, 7 days after disease onset. Abdominal perfusion pressure and filtration gradient were additionally calculated. Moreover, outcomes were assessed after 1, 3, 5, and 7 days according to visual-analogue scale.

Results. There were faster regression of intraperitoneal hypertension followed by normalization of abdominal pressure after 7 days in group 1 compared with group 2 (p ≤ 0.05). Data of visual-analogue scale confirmed patients’ good tolerability of resonance stimulation including absent local discomfort during electrodes deployment and better state of health compared with group 2 (p ≤ 0.05). Infectious complications rate was 20.9% in group 1, 38.1% – in group 2. Sepsis developed in 3 (7%) patients of group 1 and in 7 (16.6%) patients of group 2. Overall mortality was 7% and 14.3% in both groups, respectively.

Сonclusion. Percutaneous resonance stimulation is able to improve outcomes in patients with severe acute pancreatitis.

Aim. To determine the possibility, necessity and safety of self-expanding covered endobiliary stents in benign biliary strictures caused by chronic pancreatitis.

Material and methods. Nine patients with painless chronic pancreatitis complicated by obstructive jaundice syndrome were enrolled. Minimally invasive treatment included stage-by-stage percutaneous transhepatic cholangiostomy by pigtail 8Fr drain followed by its transformation to temporary transpapillary external-internal drainage. Then we performed antegrade endobiliary stenting of stricture with self-expanding metal stent 9 mm. There were no symptoms of acute pancreatitis. External-internal drainage in within bile duct lumen has been kept for 2–4 weeks to control position and patency of the stent.

Results. Technical success of antegrade deployment of self-expanding covered stent into transpapillary position was achieved in all patients. The time of complete opening of the stent was 2 days. Ultrasonic control every 2 months was applied since stent has been installed. All 9 stents were successfully and uneventfully extracted endoscopically after 6–12 months. There were no cases of recurrent mechanical jaundice. Mean disease-free follow-up was 22.8 months.

Conclusion. Covered stent opening followed by stricture dilation up to 8-10 mm within distal common bile duct confidently eliminates biliary hypertension. Stenting of this area is followed by formation of stable periductal carcass within 6–9 months which is preserved even after endoscopic extraction of the stent. Minimally invasive management of biliary hypertension using covered self-expanding metal stent in transpapillary position may be an alternative to traditional surgery in selected patients with chronic pancreatitis and mechanical jaundice as predominant clinical syndrome.

Aim. To analyze complications of percutaneous transhepatic cholangiostomy depending on biliary obstruction level and drainage type.

Material and methods. Percutaneous transhepatic biliary drainage was carried out in 974 patients with mechanical jaundice of different genesis. External drainage was predominantly performed for distal obstruction, external-internal suprapapillary – for proximal obstruction. Strictures of biliodigestive anastomosis were managed using percutaneous balloon dilatation and long-term external-internal drainage.

Results. Overall morbility was 19.1%. Significant relationship between morbidity and obstruction level, drainage type and tubes quantity was detected. Drainage tube dislocation was the most common drainage-related complication both in proximal and distal obstruction. External-internal transpapillary drainage was followed by suppurative cholangitis and acute pancreatitis in 81.5% of cases. External-internal suprapapillary drainage was accompanied by acute cholangitis in 17.1% of patients and was determined by disconnection of subsegmental ducts that required additional drainage tubes placement. In most cases, complications were corrected by minimally invasive surgery and nonsurgical treatment. Overall mortality was 1.3% (0.3% in cases of distal obstruction and 1.8% in cases of proximal obstruction).

Conclusion. Percutaneous transhepatic biliary drainage is a routine non-traumatic method of biliary decompression that may be successfully used irrespective to obstruction level and cause of jaundice. External-internal suprapapillary drainage is preferable for proximal biliary obstruction while external-internal transpapillary drainage should be avoided. 

Literature data for liver echinococcosis are reviewed. Various classifications, modern instrumental and laboratory diagnostic methods as well as effective treatment are analyzed. Liver echinococcosis requires timely diagnosis as a common disease. Conservative and surgical methods for echinococcosis complement each other and require individual approach. Chemotherapy with albendazole is mandatory to prevent recurrence.

It is presented case report of multiple endocrine neoplasia type 1 (Wermer’s syndrome). This syndrome is characterized by a large variability of clinical manifestations. In our case, there was a combination of primary hyperparathyroidism and simultaneous neuroendocrine tumors of the pancreatic tail and portal area. We have not found similar cases with portal gastrinoma in the available literature. Simultaneous subtotal parathyroidectomy, distal pancreatectomy with excision of portal insulinoma and partially extrahepatic bile ducts followed by hepaticojejunostomy were performed. This observation demonstrates the modern diagnostic and surgical methods in patients with MEN-1 syndrome and neuroendocrine tumors.

The clinical observation of a patient with pancreatic head cancer and intrapancreatic location of the portal vein is described. Surgical features of pancreatoduodenectomy, intraoperative complexities due to portal vein localization are comprehensively presented. Literature data are reviewed.

The patient with neoplasm of major duodenal papilla combined with choledocholithiasis is described. Obstructive jaundice is one of manifestations complicating the course of these diseases. Complex approach to current diagnostic and therapeutic minimally invasive technologies is demonstrated. It is also presented literature review.