Implementation of transplantation techniques in liver resection is one of the most difficult and perspective ways to expand indication for radical treatment of locally advanced liver tumors including malignancies. The number of procedures is growing slowly with gradual improving of immediate and long-term outcomes that justifies further investigation of this surgical field. It is presented review of recent data devoted to different types of liver autotransplantation.

Aim. To evaluate the possibilities and indications for ALPPS, immediate and long-term results of surgical treatment of alveolar echinococcosis including great vessels invasion in case of small remnant liver volume.

Material and methods. There were 30 ALPPS procedures. Seven patients had small future liver remnant (FLR) — 24.5% (22.4—26.7%). Bile ducts repair with Roux-en-Y procedure for biliodigestive anastomosis during the first surgical stage was performed in 5 patients (71.4%). ALPPS combined with great vessels resection (portal vein or portal vein and left hepatic vein) was required in 4 patients (57.1%). RO-resections were carried out in all patients.

Results. Mean duration of ALPPS stage I was 365 (330—415) min, intraoperative blood loss — 800 (700—1000) ml. Time of stage II was 85 (70—110) min, intraoperative blood loss — 200 (100—300) ml. The second stage of ALPPS was performed in 6—7 days (max 8 days) after preliminary assessment of FLR volume according to CT-volumetry, which was 570 (430—630) ml (37.9% (31.9—52.4%) in relation to FLR volume before the first stage of ALPPS. Augmentation of FLR volume was 200 (150—290) ml (60.9% (48.3—80.6%)). The daily increase of FLR volume was 29 (23—46) ml. Overall postoperative morbidity was 42.9% (complications grade I were noted in 2 patients (28.6%), grade IV — in 1 patient (14.3%). Incidence of post-hepatectomy liver failure grade A (ISGLS, 2011) after ALPPS stage II was 42.9% (n = 3). Bile leakage grade A (ISGLS, 2011) occurred in 28.6% of cases (n = 2). Mortality was absent. Postoperative hospital-stay after stage II was 22 (18—35) days. Maximum follow-up was 50 months. Long-term disease-free survival was 100%, median survival — 29 months.

Conclusion. ALPPS technique is feasible, followed by desired increase of FLR volume and safe hepatectomy. The procedure leads to good immediate and long-term postoperative results in patients with alveolar echinococcosis and small FLR volume regard less invasion of afferent and/or efferent liver vessels.

Aim. Analysis of the techniques of advanced liver resections involving transplantation technologies which affect the results of surgery for advanced liver alveococcosis.

Material and methods. There were 65 patients with massive complicated liver alveococcosis for the period from 2008 to 2018. Radical procedures were applied in 82% of cases (n = 53). Mechanical jaundice was observed in 45% of

patients, portal hypertension — in 25%. Previous palliative surgery was applied in 58% of patients. Thirty-three patients (50.8%) had advanced parasitic lesion with involvement of afferent and (or) efferent vascular structures. Distant metastases were detected in 6 patients: metastatic lung lesions occurred in 5 of them, simultaneous injury of brain and lungs — in 1 case.

Results. There were 47 RO-resections with application of transplantation technologies including 4 extracorporeal resections and 6 orthotropic liver transplantations. Reconstruction of great afferent and efferent vascular structures was performed in 47% of cases: IVC repair — 25 cases, PV repair — 25 cases. Resection of extrahepatic bile ducts was made in 33 cases. Postoperative complications occurred in 26 cases: Clavien-Dindo type II — 5, IIIb — 13, IVb — 2, V — 6. Bile leakage ISGLS class B occurred in 6 cases, class C — in 11 cases.

Conclusion. Transplantation technologies for advanced liver resections and liver or its segment transplantation allow to achieve radical surgery in 82% of patients. Advanced operations are indicated for advanced liver alveococcosis due to good outcomes. There are various technical aspects of such operations which are useful to avoid most of complications.

Aim. To evaluate short-term outcomes of ex situ, ex vivo liver resection in patients with lesion of liver veins confluence and inferior vena cava who were undesirable for conventional liver resection.

Matherial and methods. There were 4 procedures of ex situ liver resection and autotransplantation without veno-venous bypass.

Results. Postoperative complications developed in all cases, complications grade IIIa and over — in 50% of patients. Three patients are alive without signs of disease, follow-up ranged from 8 months to 2 years. One patient died after surgery.

Conclusion. Comprehensive planning of such procedures is a key for good early and long-term postoperative outcomes. It is strongly recommended to perform liver autotransplantation in well experienced specialize center due to difficult and traumatic surgery.

Liver transplantation is currently controversial for colorectal cancer metastases and not recommended in clinical guidelines. We report the first Russian case of liver transplantation from cadaveric donor in a patient with multiple bilobar unresectable liver metastases of colon cancer. We observe no recurrences within 10 months on everolimus-based immunosuppression and adjuvant treatment. The current state of the problem and the place of liver transplantation in metastatic colorectal cancer treatment are discussed in a short review.

Peritoneal dialysis is preferable in children and young adults with end-stage chronic renal failure. Early onset or resumption of peritoneal dialysis in patients undergoing abdominal surgery are very limited. It is presented case report of effective peritoneal dialysis on the second day after hemihepatectomy.

Aim. To determine prognostic criteria of variceal bleeding in patients with portal hypertension.

Material and methods. There were 53 patients with portal hypertension and the threat of variceal bleeding from the esophagus and stomach without previous hemorrhage. Univariate and multivariate analysis was applied to determine prognostic criteria of the first bleeding. Patients with esophageal and gastroesophageal varices were analyzed separately. The following prognostic criteria were considered: dimensions of the veins, vasculopathy and gastropathy, liver function.

Results. Incidence of hemorrhage was 72.7% in patients with esophageal varices grade 3, in case of vasculopathy — 80%. Child-Pugh class A was followed by incidence of hemorrhage near 12.5%, class B — 44%, C — 100%. MELD score < 9 was associated with bleeding rate 28.6%, 10—19 — 39.3%, over 20 scores — 100%. According to multivariate analysis consisting of Child—Pugh classification, in patients with < 11 scores 1-year incidence of bleeding was 13.3%, in case of MELD classification — 16.7%. The same values in patients with 11—16 scores were 77.8% and 31.3%, respectively. Analysis including both classifications (overall score over 16) was associated with incidence of hemorrhage up to 100%. Gastroesophageal varices grade 3 were associated with the risk of hemorrhage near 44.4% within 12 months, in case of vasculopathy — 60%, gastropathy — 37.5%. Incidence of hemorrhage in patients with Child-Pugh class A was 12.5%, class B — 44%, class C — 100%. In patients with MELD score < 9 bleeding rate was 28.6%, 10—19 scores — 39.3%, over 20 scores — 100%. According to multivariate analysis consisting of Child—Pugh classification, patients with gastroesophageal varices and less than 11 scores have the probability of hemorrhage near 15.4% within 12 months, in case of MELD score — 23%. The same values were 55.6% and 50%, respectively in case of 11—18 scores. In patients with more than 18 scores incidence of hemorrhage was 75% considering Child-Pugh classification and 100% for the MELD classification.

Conclusion. The group of patients with threat of bleeding within 12 months was determined that makes possible a differentiated approach to patients who for need primary prevention of bleeding.

Aim. To analyze anatomic variants of arterial and venous blood supply of liver in potential liver donors by using of CT-angiography (CTA).

Material and methods. CTA data of 151 potential donors have been examined for the period 01.01.2016-01.01.2018. Non-ionic iodine-containing (320 mg/ml) contrast agent was used at a dose of 1.4 ml/kg and infusion rate near 4.0 ml/s. Variants of arterial anatomy were classified according to N. Michels, portal vein anatomy — according to T Nakamura classification (2002).

Results. N. Michels type I was the most common variant of arterial structure (n = 108, 71.5%). Types II and III were observed in 8.6% and in 7.9% of cases, respectively. Types IV and IX included the same number of donors (2.6%). Types VII and VIII were the rarest (0.7% and 1.3%). Types V, VI, X were absent. There were 7 cases (4.6%) with arterial variants which are not described by N.Michels classification. Moreover, 3 types were not previously described by other authors.

Conclusion. Hepatic artery variations coincide with the classification of N. Michels as a rule (95.4%). Other anatomic variants not described in this classification were observed only in 4.6% of cases.

Aim. To clarify the indications for video-assisted retroperitoneal debridement at the late stage of pancreatic necrosis. Material and methods. Acute pancreatitis was diagnosed in 1468 patients throughout 2012-2018. Severe destructive pancreatic necrosis occurred in 364 (24.8%) patients. Infected pancreatic necrosis needed for surgical treatment in 264 cases. We used video-assisted retroperitoneal debridement in 20 patients (8.1%).

Results. Video-assisted retroperitoneal debridement was not associated with “open” surgery in 6 patients. There were 2-6 redo VARD procedures per patient. We diagnosed the “left-sided” and “right-sided” models of pancreas and peripancreatic space infiltrationin 4 and 2 patients, respectively. There were 14 patients who needed an “open” surgery besides video-assisted retroperitoneal debridement due to advanced inflammation. Bleeding was the only complication and occurred in 2 patients. There was 1 unfavorable outcome.

Conclusion. Video-assisted retroperitoneal debridement is an effective minimally invasive approach of debridement. Video-assisted retroperitoneal debridement combined with percutaneous catheter drainage is preferable for “leftsided” and “right-sided” infiltration of pancreas and peripancreatic tissue. It is advisable to combine video-assisted retroperitoneal debridement with open surgery for “mixed model” of infiltration.

Aim. To examine the efficiency of perioperative enteral nutrition in patients with chronic pancreatitis who underwent elective pancreatectomy.

Material and methods. Prospective randomized study of the effect of early enteral nutrition on the results of surgical treatment of chronic pancreatitis has been conducted for the period from January to December 2017. In the main group 20 patients received Peptamen AF 3 days before surgery and 5 days after in addition to parenteral nutrition. Only parenteral postoperative nutrition was prescribed in 20 patients of the control group. Morbidity, ICU-stay and hospital-stay, peristalsis onset timing and protein metabolism markers (serum albumin, transferrin) were assessed.

Results. There was a significant increase of the level of transferrin, albumin and lymphocytes after 5 and 10 days in the main group postoperatively (p < 0.001). Significantly earlier onset of peristalsis (1,5 [1; 2] compared with 3,5 [2; 5] days, p = 0.002) and earlier stool (4 [3; 5] and 6.5 [4; 7] days, p = 0.002) were also revealed in the main group. Incidence of anastomotic leakage and intra-abdominal infection was less in the main group (p = 0.31). ICU-stay and hospital-stay were also significantly shorter in the main group (12.5 and 18.5 days, p = 0.001).

Conclusion. Perioperative enteral nutrition by using of Peptamen AF decreases postoperative morbidity, hospital-stay and cost of treatment.

Despite significant progress in experimental oncology over the last few years, surgical approach is still gold standard in patients with different types of cancer including liver malignancies. Development of surgical techniques significantly improved immediate results of treatment. However, it should be noted that postoperative life expectancy is under much less attention in surgical practice. Different ways to achieve radical operations and improve long-term outcomes are reviewed in the article.