In 2023, with the approval of the leadership of the Hepato-Pancreato-Biliary Association of Commonwealth of Independent States, a consensus study was initiated and conducted on the diagnosis, management, and follow-up of patients with serous and mucinous neoplasms of the pancreas. Based on an extensive literature review, responses to each of the 22 questions posed were formulated and compiled into a Consensus Document. A total of 44 experts representing 27 institutions across 9 countries participated in the preparation of the Consensus. The Delphi method was employed for voting, and ultimately, including the results of votes on selected statements during the final conference, consensus was achieved on all questions.

Aim. To analyze the outcomes of patients with pancreatic cystic tumors managed at a high-volume hepato-pancreatobiliary (HPB) surgery center.

Materials and Methods. Between 2014 and 2025, a total of 386 pancreatic resections were performed, with 82 (21.24%) for pancreatic cystic tumors. The mean patient age was 51 ± 10.7 years, and 63.4% of the patients were female.

Results. Of the patients who underwent surgical operations, 10 (12.1%) had branch-duct intraductal papillary mucinous neoplasms (IPMNs), and 13 (15.88%) had main-duct IPMNs. Additionally, 25 patients (30.53%) were treated for mucinous cystic neoplasms, 1 (1.21%) for a cystic neuroendocrine tumor, 21 (25.63%) for solid pseudopapillary neoplasms, and 12 (14.63%) for serous cystadenomas. A retrospective pathohistological analysis of 121 cases of pancreatic head cancer following pancreatoduodenectomy revealed that 31 patients (25.61%) had developed adenocarcinoma associated with mucinous ductal neoplasms of various types.

Conclusion. Pancreatic cystic tumors exhibit variable biological behaviors, necessitating differential diagnosis and management.

Aim. To optimize the differential diagnosis of pancreatic cystic lesions by introducing novel endoscopic ultrasound (EUS) technologies into clinical practice.

Materials and Methods. The study analyzed the outcomes of multimodal diagnostic evaluation in 424 patients with pancreatic cystic lesions who underwent EUS.

Results. In 328 cases (77.4%), conventional B-mode EUS provided sufficient diagnostic information. In 96 cases (22.6%), contrast enhancement was required: 59 patients (61.5%) underwent assessment of contrast uptake by the cyst wall, septa, and solid components; 25 (26%) only by the wall and septa; and in 12 (12.5%) assessment was made ofnodular components of the pancreatic cystic lesions. Retrospective analysis demonstrated that contrast-enhanced EUS increased overall diagnostic accuracy for differentiating cystic neoplasms from post-necrotic pseudocysts by 14.7%, improved detection of solid components within cystic lesions by 11.3%, and enhanced identification of cystic adenocarcinomas or intraductal papillary mucinous neoplasms (IPMNs) associated with adenocarcinoma by 9.9%. The integration of contrast enhancement into the EUS diagnostic algorithm significantly reduced the number of fineneedle aspirations (FNA) required.

Conclusion. Both our clinical experience and data from international research underscore the necessity of incorporating multimodal EUS into the diagnostic work-up for cystic pancreatic lesions. Based on the study, an algorithm was developed for applying novel EUS technologies in the differential diagnosis of pancreatic cystic tumors.

Aim. To analyze current perspectives on the concept of malignant progression in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas and to outline the most prospective research trends in this area.

Materials and Methods. A literature review and an analysis of data from the cancer registry of Moscow were conducted. Results. The paper summarizes key molecular genetic studies from recent decades. Using surgical specimen data coded according to ICD-O in Moscow for the years 2023–2024, the main challenges in the histopathological diagnosis of IPMN with associated invasive carcinoma are discussed.

Conclusion. Genomic alterations in IPMNs of the pancreas, as background lesions for pancreatic ductal adenocarcinoma, reflect their genetic heterogeneity and carry significant clinical implications for understanding the polyclonal theory of carcinogenesis, as well as for identifying novel therapeutic targets and approaches. The invasive component associated with IPMN is frequently genetically independent based on its molecular profile.

Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cystic lesions with malignant potential. This review outlines current guidelines, surgical indications, outcomes, and surveillance strategies. It also highlights recent advances in minimally invasive surgery and emerging biomarkers aimed at improving risk stratification and reducing unnecessary resections.

Aim. To investigate the role of tumor localization and histogenesis as risk factors for postoperative complications and mortality following multivisceral surgical procedures involving pancreaticoduodenectomy.

Materials and Methods. This study included all patients (n = 251) who underwent multivisceral surgery with pancreaticoduodenectomy for tumors of various localizations at two medical institutions.

Results. Comparative analysis of pancreatic parenchymal density revealed statistically significant differences between pancreatic cancer and cancer of the major duodenal papilla (p = 0.012), distal common bile duct cancer (p = 0.040), duodenal tumors (p < 0.001), secondary pancreatic tumors (p < 0.001), colorectal cancer (p < 0.001), renal cancer (p = 0.027), and gastric cancer (p < 0.001). Statistically significant differences were also observed in the following pairwise comparisons: major duodenal papilla cancer vs. colorectal cancer (p = 0.010); neuroendocrine tumor of the pancreatic head vs. colorectal cancer (p < 0.001); pancreatic neuroendocrine tumor vs. gastric cancer (p = 0.006). For pancreatic duct diameter, significant differences were found between duodenal tumors and pancreatic cancer (p = 0.016), colorectal cancer and pancreatic cancer (p < 0.001), gastric cancer and pancreatic cancer (p = 0.016). The overall rate of postoperative complications in the study group was 65.7% (n = 165), with a mortality rate of 7.2% (n = 18). The likelihood of developing a postoperative pancreatic fistula was significantly higher in patients with distal common bile duct cancer (AOR 5.9; 95% CI: 1.4–24.6, p = 0.015), secondary malignancies of the pancreatic head (AOR 4.7; 95% CI: 1.06–21.0, p = 0.041), and gastric cancer (AOR 2.8; 95% CI: 1.048–7.691, p = 0.040). The risk of dehiscence of pancreatic-digestive anastomosis significantly increased in patients with distal common bile duct cancer (AOR 7.8; 95% CI: 1.7–35.05, p = 0.007). In patients with secondary malignancies of the pancreatic head, postoperative mortality was significantly higher (AOR 9.7; 95% CI: 1.79–52.8, p = 0.008).

Conclusion. Tumor localization and histogenesis may serve as independent predictors of early outcomes following multivisceral surgery with pancreatoduodenectomy. Cancer of the pancreatic head generally has the most favorable prognosis among pancreatic tumors, and its location is associated with a lower risk of postoperative complications. In contrast, surgeries for distal common bile duct cancer, metastatic lesions of the pancreatic head, and gastric cancer are associated with significantly worse short-term outcomes.

Aim. To evaluate the short-term outcomes of enucleation and resection procedures for G1 and G2 pancreatic neuroendocrine tumors (PNETs).

Materials and Methods. The study included 171 patients diagnosed with G1 and G2 pancreatic neuroendocrine tumors. Pancreatoduodenectomy was performed in 25 patients, distal pancreatic resection in 60, and tumor enucleation in 86 cases.

Results. Neuroendocrine tumors in the head and neck of the pancreas were identified in 79 patients. Enucleation was performed in 54 cases, and pancreatoduodenectomy in 25. Postoperative complications following enucleation occurred in 22 patients (40.7%), with 1 death; complications after pancreatoduodenectomy were observed in 9 patients (36%), also with 1 death. Tumors located in the body and tail were diagnosed in 92 patients. Enucleation was performed in 32 cases, and distal pancreatic resection in 60. Postoperative complications occurred in 5 patients (15.6%) after enucleation and in 27 patients (45.5%) after distal pancreatic resection.

Conclusion. For well-differentiated pancreatic neuroendocrine tumors, enucleation is a feasible surgical option. The choice of surgical procedure depends on tumor size, its anatomic location with respect to the main pancreatic duct, and the surgeon’s clinical judgment.

Aim. To evaluate the impact of endoscopic procedure selection in the treatment of patients with major duodenal papilla adenomas, using a newly developed endoscopic classification of these lesions.

Materials and Methods. From 2000 to 2024, endoscopic surgical resection of major duodenal papilla adenomas was performed in 200 patients. Preoperative diagnosis was based on endoscopic ultrasound (EUS) in 165 cases, while in 35 cases, EUS was not used.

Results. Technical success of endoscopic resection of major duodenal papilla adenomas was 100% in both groups. The incidence of postoperative complications was 16.9% in the main group and 40% in the comparison group. During long-term follow-up, the adenoma recurrence rate was 6.6% in the main group and 20% in the comparison group.

Conclusion. A patient-specific choice of the optimal procedure for surgical resection of major duodenal papilla adenomas, depending on classification-based typing of the neoplasm, reduces the rate of postoperative complications and resection radicality.

Our aim is to identify the prognostic factors for post-operative residual stone.

Methods. Our retrospective study recruited 201 participants with hepatolithiasis and bile duct stenosis who underwent choledochoscopic lithotripsy with or without parenchyma incision and hepatic resection in Department of Hepatobiliary surgery, VietDuc University hospital, Hanoi, Vietnam from 1/2018 to 12/2020. Demographic information, clinical features, laboratory results, type of operation, bile duct stenosis characteristics (site, number, severity) were collected. Our primary endpoint was the post-operative stone clearance rate.

Results. 82.6% had one stricture site, 49.8% had a severe stricture. The stone clearance rate after CEHL was 43.2, and combined hepatectomy/parenchymal incision was 75.3%. Multiple approaches and type of intrahepatic stone are two associated factors for residual stone.

Conclusion. Choledoscopy is a valuable tool in finding gallstones and acquiring bile duct characteristics. Hepatectomy and parenchymal incision, along with choledoscopic lithotripsy, is a safe and effective method for increasing the clearance rate for hepatolithiasis and bile duct stricture. Comprehensive and aggressive treatment is needed in complicated intrahepatic stones.

Aim. To analyze current methods of diagnosis and endoscopic management of Wirsungolithiasis and to present a clinical case demonstrating the successful staged endoscopic management.

Material and Methods. A literature review was conducted, and a clinical case of a female patient with Wirsungolithiasis complicated by acute obstruction of the major duodenal papilla was described. Results. Endoscopic methods enabled resolution of papillary obstruction, removal of pancreatic duct stones, and restoration of ductal patency, thereby avoiding open pancreatic surgery. Following three stages of management (sphincterotomy, lithextraction, and restenting), the patient’s condition and laboratory parameters normalized.

Conclusion. Endoscopic methods (lithotripsy, stenting) are standard procedures for Wirsungolithiasis due to their minimally invasive nature, efficacy, and low risk of recurrence. However, complications associated with stenting require strict monitoring. Clinical surveillance supports the necessity for a staged approach and the development of standardized protocols to optimize outcomes.