The purpose of this publication is to analyze international clinical guidelines and clinical trial data on the diagnosis of hepatocellular carcinoma and demonstrate the possibilities of using MRI with hepatobiliary magnetic resonance contrast agent. As well as an evaluation its diagnostic advantages in comparison with other diagnostic methods such as ultrasound, CT and MRI with extracellular contrast agents.

Material and methods. Abstracts of 331 scientific articles for the period 2014–2020 were selected in the PubMed information and analytical system for the keywords: “hepatocellular carcinoma”, “US”, “CT”, “MRI”, “gadoxetic acid”. Articles about technical aspects and clinical cases were excluded. After the analysis of full-text articles, 32 publications were selected.

Results. The presented review has demonstrated the diagnostic advantages of MRI with hepatobiliary magnetic resonance contrast agents and a wide range of its application at all stages of care for a patient with hepatocellular carcinoma.

Conclusion. Despite the existing variety of methods for diagnosing hepatocellular carcinoma, the leading direction in this area is currently MRI with gadoxetic acid. The high diagnostic efficiency of gadoxetic acid makes it possible to increase the accuracy of the imaging and to choose the optimal management for each patient.

To investigate the dependence of textural parameters of pancreatic ductal adenocarcinoma on using standard and low-dose CT protocols.

Materials and methods. The study included 52 consecutive patients with histologically confirmed pancreatic ductal 

adenocarcinoma who underwent contrast enhanced computed tomography using standard (120 kV) and low-dose (100 kV) scanning protocols. We compared radiomics features of the identical histological tumors in all scanning phases.

Results. We calculated 53 radiomics features in all types of pancreatic ductal adenocarcinoma grade differentiation for all scanning phases. We identified that out of 53 features of texture analysis, less than half was statistically different for each scan phase (11 parameters (20.8%) for the unenhanced phase; 18 parameters (34%) for the arterial; 19 parameters (35.8%) for the venous and delayed scanning phases), in all types of tumor differentiation (GLCM_ Contrast, GLCM_Correlation, GLCM_Dissimilarity, GLRLM_SRHGE etc., p < 0.05).The diagnostic accuracy of more than 50% of the radiomics features is preserved when changing kV in the CT scan protocol.

Conclusion. The use of a low-dose CT protocol doesn’t affect the diagnostic accuracy of the features of texture analysis in the preoperative assessment of the degree of differentiation of pancreatic ductal adenocarcinoma.

Aim. To evaluate the capabilities of CT and MRI in the assessment of resectable and potentially resectable pancreatic tumors.

Materials and methods. From 2015 to 2020 CT and MRI examination of the abdomen was performed in 220 patients with pancreatic ductal adenocarcinoma. The average age of the patients was 54.6 ± 9.9 years. 198 (90%) patients had a tumor of the pancreas head, 22 (10%) patients had a tumor of the body or tail of the organ. 110 (50%) people were recognized as inoperable. The results of examination of 88 (40%) patients were subjected to in-depth analysis.

Results. Eighty eight patients were assessed for tumor resectability. In 36 (40.9%) cases, the neoplasm was recognized as resectable, and the standard resection was performed. In 52 (59.1%) cases, the tumor was determined as borderline resectable; extended gastropancreatoduodenal resection was performed.The usefulness of CT was shown in assessing the features of the variable vascular anatomy of the hepatopancreatobiliary area, determining the nature of the involvement of key vessels in the pathological process and lesions of the pancreas as a whole. The importance of using multiphase CT scanning is demonstrated and emphasized. The advantages of the MRI are indicated, including examples of the effective use of diffusion-weighted images.

Conclusion. Multiphase MDCT and MRI with dynamic contrast enhancement are the leading methods of radiological diagnosis of malignant tumors of the pancreas and effectively complement each other.

Aim. To evaluate opportunity of computed tomography in diagnosis and decision making in patients with pancreatic surgery complications and possibility of interventional procedures in its treatment.

Materials and methods. 50 patients underwent pancreatic surgery in 2018-2020 (45 Whipple procedure and 5 distal pancreatectomies). 45 patients underwent computed tomography in post-surgery course. The complications occur in 29 patients; complications were found by computer tomography in 26 patients.

Results. The most frequent complication was pancreatic fistula (24%) in typical places: upper edge of the pancreatojejunostomy (25%) and in the bed of the resected pancreatic head (50%). Delineated fluid collections on computed tomography scans were more prevalent in patients with complicated course (57.9% vs. 26.3%). The average size of fluid collections was increased in the group of complicated courses (51,9 × 28,1 mm vs. 42,2 × 20, 6 mm).  Interventional procedures were performed in 18 patients (62% of complicated patients). The average number of such interventions per patient was 2.95. Using interventional techniques as the only method of surgical treatment, 13 patients were cured (50% of complicated patients). In 14 patients, interventions were planned and performed based on control computed tomography. Postoperative bleedings were detected in 8 patients (16%). In 4 cases it revealed ongoing bleeding by computer tomography, in 3 cases – completed, which allowed us to determine further treatment tactics.

Conclusion. Performing computed tomography after pancreatic surgery allows to identify postoperative complications before their clinical manifestation and plan their treatment. The optimal time for performing computed tomography is 5–6 days after surgery. Performing CT angiography for suspected bleeding in some cases allows to avoid invasive angiography and choose the method of endovascular hemostasis in appropriate situations. The combination of various interventional techniques allows to avoid relaparotomy in most patients with intraabdominal complications.

Aim. To establish the parameters of gastric varices which determine a high risk of gastric bleeding according to the results of multispiral computed tomography.

Material and methods. The results of studies of 39 patients with liver cirrhosis and gastric varices were retrospectively studied. Nine of them had signs of previous bleeding on endoscopic examination or the corresponding data in the medical history. In 3 patients gastric bleeding occurred 30-47 days after multispiral computed tomography.

Results. According to the results of multispiral computed tomography with multiplanar reconstructions gastric bleeding was detected in 12 patients with protrusion of submucosal varicose veins into the gastric lumen by 5 mm or more with a vein diameter >7 mm.

Conclusion. The results of multispiral computed tomography, complemented by the hydro-computed tomography technique, provide important additional information on predicting the development of gastric bleeding in the selection of patients for preventive minimally invasive interventions on the veins of the stomach.

Aim. To present the first successful full-split liver transplantation for two adults recipients in Russia.

Materials and methods. The first successful full-split liver transplantation for two adults in ex situ way in Russia was made on 26^th of September 2014 in the Burnasyan Federal Medical Biophysical Center of FMBA. The deceased donor was inside UNOS, Lee. The GRWR index in both recipients was near 1. The first recipient had been in a waiting list for 1 year, the second for 4 months. Both recipients had got liver cirrhosis in terminal stage.

Results. The surgical procedure length was 650 and 660 min. The overall time of cold ischemia was 510 min. We observed a primary function of each graft. ISGLS B and Clavien-Dindo 3A biliary leak complications were observed in both recipients. Both patients were discharged after 33 and 34 days. Overall survival for this moment is 68 months.

Conclusion. Full-split liver transplantation for two adults in ex situ way seems to be a complicated procedure both from the technical and organizing points of view. It demanding good mastership and coordination between surgical team members. At the same time, that treatment method has to be spread widely to improve treatment of patients with end-stage cirrhosis results.

Aim. To analyze the safety and advantages of central resection in comparison with extended hepatectomies.   Methods. From June 2017 to May 2020 29 central and extended liver resections for children were performed. Central hepatic resections were carried out in 8, extended hepatectomies – in 21 patients. Preoperative investigations, intraoperative and postoperative data in both groups were analyzed.

Results. The main indication for surgery was hepatoblastoma. Future liver remnant volume was significantly higher in central resections group (р = 0.003). No difference in median operative time (р = 0.94), intraoperative blood loss (р = 0.078) and blood transfusion rate (р = 0.057) were found between groups. There were no postoperative complications difference. Also no difference in hospital stay length (р = 0.3) were found.

Conclusion. In comparison with extended procedures, central liver resection has similar complication rate. Central hepatectomy is a safe procedure in children with liver tumors, which allows to preserve more healthy parenchyma.

Aim. Improving outcomes of diagnosis and treatment of patients with liver echinococcosis and its complications. Materials and methods. A comparative analysis of the results of surgical treatment of liver echinococcosis and its complications with traditional laparotomy access surgery (control group) and minimally invasive interventions (main group) was performed.

Results. The study included 300 patients (170 in the control and 130 in the main group). In the main group, 37 (28.4%) cases performed open echinococcectomy from various mini-accesses, and 27 (20.7%) performed twostage operations using minimally invasive technology. Laparoscopic echinococcectomy was performed in 23 (17.7%) patients, laparoscopic pericystectomy 12 (9.2%) and laparoscopic liver resection in 10 (7.7%) patients. The frequency of postoperative complications in the main group was 17.7%, in the control 51.8%, postoperative mortality decreased from 2.3% to 0.8%.

Conclusion. Minimally invasive technologies in the surgical treatment of liver echinococcosis show the better immediate results compared to traditional open surgical methods.

Aim. To improve the surgical treatment results among patients with synchronous liver metastasis of colorectal cancer. Materials and methods. From 2012 to 2019, the analysis of the results of treatment of 60 patients with colorectal cancer and synchronous metastatic liver disease was carried out. The study sample was divided into 2 groups of patients. The group 1 consisted of 30 patients who got simultaneous resection of liver metastases and primary colorectal cancer. The group 2 consisted of other 30 patients who got stage resections: surgery for the primary tumor at the first stage, and liver surgery for metastases at the second.

Results. The median operative time was 340 ± 21.1 minutes in the group 1. In the group 2 it was 255 ± 21.1 minutes and only the liver resection stage was assessed. The median blood loss in patients of the group 1 was 520,0 [200,0;800,1] ml, in the group 2 it was 500,0 [175,0;1300,0] ml. In general, we identified 5 cases of complications. In the postoperative period, 4 patients died. The average follow-up period is 23 months. One-year survival in group 1 was 92.6%, in group 2 – 100%, three-year – 85.2% and 89.6%. One-year disease-free survival in group 1 is 70%, in group 2 – 83.3%, three-year disease-free survival – 43.3% and 36.7%.Overall and disease-free survival rates didn’t differ significantly between the two treatment strategies. We detected significant effect on the disease-free and overall survival of regional lymph nodes metastasis (both p < 0.05).

Conclusion. The long-term and immediate results of simultaneous surgery of synchronous liver metastasis of colorectal cancer are comparable to the results of the staged method of treatment. It indicates the safety and effectiveness of simultaneous procedure.

Aim. To assess the possibility of open spleen-preserving distal subtotal pancreatic resection for tumors of the body and tail of the pancreas.

Material and methods. A retrospective comparative analysis of the immediate results of the spleen-preserving interventions in 41 patients was carried out. Mainly benign tumors or tumors with a low malignancy potential of the corpus and (or) the tail of the pancreas were detected. Distal subtotal pancreatectomy with splenectomy was performed in 53 patients with pancreatic tumors of different histogenesis with low malignancy potential (control group).

Results. The duration of spleen-preserving distal subtotal pancreatectomy was 12 minutes shorter, compared with the distal subtotal pancreatectomy with splenectomy group (p = 0.180). Significantly lower volume of intraoperative blood loss during spleen-preserving procedure was noted – by 460 ml (p = 0.0001). The level of postoperative complications in the spleen-preserving pancreatectomy group was 15 (37%), while in the group of distal subtotal pancreatectomy with splenectomy was 26 (49%) (p = 0.227), respectively. External pancreatic fistula after spleenpreserving pancreatectomy was noted in 13 (32%) patients, in the other group in 21 (40%; p = 0.429). The duration of hospital stay did not statistically significantly differ in the compared groups and amounted to: 18.6 ± 6.9 and 20.3 ± 5.4 days (p = 0.123), respectively.

Conclusion. Open spleen-preserving pancreatectomy is a relatively safe type of surgical treatment for patients with benign tumors and tumors with a low potential for malignancy of the body and/or tail of the pancreas. The surgery is shorter in time, accompanied by a lower level of complications, significantly less intraoperative blood loss, compared with a similar procedure involving splenectomy.

Aim. To study the state of individual elements of the hemostasis system in liver cirrhosis according to modern literature.

Summary. The review presents an analysis of literature data covering the state of the homeostasis system in liver cirrhosis. The pathophysiological and pathogenetic mechanisms that underlie the disorders that occur in various parts of the hemostatic system in this pathology are described in a polemical style. Literature data concerning a relatively littlestudied aspect of cirrhosis – hypercoagulation are analyzed. From the standpoint of modern concepts and taking into account the peculiarities of hemostasis disorders, the pathogenetic significance of the vascular endothelium and endothelial dysfunction is postulated. As well as the role of inflammatory mediators in the development of coagulopathy and intravascular coagulation syndrome in patients with cirrhosis of the liver.

A clinical case of a rare combination of complete transposition of internal organs (situs inversus totalis) with adenocarcinoma of the major duodenal papilla is presented. In addition to situs vicserum inversus, the patient has a special variant of vascular anatomy that is not included in the generally accepted classification of variants of arterial liver anatomy according to Michaels N.A. (1955), namely: separate separation of the left and right hepatic arteries from the ventral trunk. After individual preoperative planning, a patient with a complete reverse position of the abdominal organs and non-standard vascular anatomy was performed Whipple procedure. Non-invasive CT angiography is important in a complex preoperative examination, which allows timely identification and clarification of frequently occurring features of blood supply to the hepatopancreatoduodenal zone in patients with situs inversus totalis. Such surgical interventions should be performed in large multi-specialty medical centers that have extensive experience in performing pancreatoduodenal resections.