Aim. To review the outcomes of laparoscopic and open surgeries on Segment I of the liver using the experience of a medical center.

Material and Methods. The study involved 20 patients who underwent isolated surgery on the first segment of the liver between 2015 and 2024. The patients were divided into two groups for comparison. Group 1 consisted of 15 patients (75%) who underwent laparoscopic resection of segment I. Group 2 included five patients (25%) who underwent open surgery.

Results. Data analysis revealed that 11 (55%) patients were diagnosed with malignant tumors and 9 (45%) with benign lesions. The laparoscopic and open surgery groups were comparable by age (p = 0.290), BMI (p = 0.956), ASA score (p = 1.000), and tumor size (p = 0.338). Caudal lobectomy was performed in 10 (66.7%) patients in the laparoscopic group and 2 (40%) patients in the open group (p = 0.347). The Pringle maneuver was used in 4 and 1 cases, respectively (p = 1.00). The mean blood loss was 70 (50–200) mL in Group 1 and 100 (100–200) mL in Group 2 (p = 0.197). The surgery duration was 262 ± 105 min and 220 ± 57 min, respectively (p = 0.413). R1 resection was performed only in the laparoscopic group (n = 1; p = 0.920). The duration of hospital stay was 6.6 ± 1.8 days in Group 1 and 6.2 ± 1.9 days in Group 2 (p = 0.678). According to the Clavien-Dindo classification, postoperative complications above Grade II did not occur.

Conclusion. Perioperative outcomes for laparoscopic surgery revealed no deterioration when compared to open isolated resection of segment I and caudal lobectomy in a specialized department of a medical center.

Aim. To review the experience of performing simultaneous combined hepatectomy and colorectal resection.

Material and Methods. The treatment outcomes of 60 patients with colorectal cancer and synchronous oligometastases in the liver were retrospectively analyzed. In 15 (25 %) patients, the primary tumor was located in the right segments of the colon; in 27 (45 %), in the left segments; and in 18 (30 %), in the rectosigmoid region and rectum.

Results. Atypical hepatectomy was performed in 44 (73.4 %) patients, segmentectomy in 9 (15 %), and hemihepatectomy in 7 (11.7 %). Right hemicolectomy was performed in 15 (25 %) patients, left hemicolectomy in 6 (10 %), and resection of the sigmoid and rectal colon in 39 (65 %). Laparoscopic surgery was carried out in 28 (46.7%) cases. Postoperative complications of 3A Grade or higher developed in 22 (36.7%) patients, and the 90-day mortality rate was 1.6 %. Complications were associated with a metastasis size of ≥ 2 cm (OR = 4.29; р = 0.005) and blood loss of ≥ 255 mL (OR = 4.07; р = 0.048). The overall two-year survival rate was 73.9%. Risk factors for overall survival involved ≥ 3 metastases (OR: 2.56; р = 0.001) and right-sided tumor location (OR = 5.59; р = 0.019). The two-year progression-free survival rate was 25.1 %. Risk factors for progression-free survival included ≥ 3 metastases, postoperative complications of grade ≥ 3A, ≥ 2 metastases in regional lymph nodes, and metastasis size.

Conclusion. Simultaneous combined surgeries for patients with colorectal cancer and synchronous liver metastases can be routinely performed at specialized cancer hospitals. However, prospective studies are needed to identify risk factors for postoperative complications in this patient population.

Aim: To determine primary causes and mechanisms of hepatic cystic echinococcosis recurrence in order to improve prevention strategies and surgical management.

Materials and Methods. A retrospective clinical, anatomical, and epidemiological analysis was conducted to investigate the causes of recurrent hepatic cystic echinococcosis in 273 patients who received initial treatment at various medical facilities across the country between 2005 and 2023.

Results. Of the total sample, 84.6 % of cases were classified as probable residual or implantation (secondary) echinococcosis, primarily due to diagnostic and technical issues during initial procedures. The probability of true reinfection was 15.4 %. Residual and surgery-related complications were reported more frequently in district and city hospitals, which reflects the limitations of their diagnostic capabilities and non-standardized surgical practices. These findings underscore the need for pathogenetic differentiation of recurrences and highlight the key role of initial treatment quality and epidemiological factors in recurrent disease development.

Conclusion. A comparison of clinical and anamnestic data revealed three groups of recurrence causes: diagnostic errors, tactical and technical shortcomings, and true recurrence resulting from reinfection.

Aim. To evaluate the clinical efficacy of an improved algorithm for selecting minimally invasive techniques designed to improve surgery outcomes for patients with hepatic cystic echinococcosis.

Materials and Methods. A controlled cohort study was conducted to evaluate treatment outcomes in 123 patients. The comparison group consisted of 59 patients, and the main (prospective) group comprised 64 patients. The developed algorithm was applied to the main group. The selection criteria for the method included the morphological type of the cyst according to the WHO classification (CE1–CE5), its size and location. The results of puncture procedures (PAIR/PEVAC) and laparoscopic interventions were compared. Furthermore, the outcomes of 112 open surgeries in patients who did not meet the criteria for minimally invasive treatment were evaluated. Long-term outcomes (12–36 months) were assessed using an original scale that included clinical, laboratory, and ultrasound parameters.

Results. After the algorithm was implemented, the approach changed. The proportion of puncture procedures decreased from 69.5 % to 25.0 % (p < 0.001) due to its use being limited to small cysts (4.9 ± 2.3 cm). Following punctures, the incidence of infectious complications decreased from 41.5 % to 9.5 % (p = 0.024), and the rate of recurrent surgery decreased from 17.1 % to 0 % (p = 0.049). The proportion of favorable long-term outcomes with PAIR/PEVAC increased to 81.0 %, compared to 24.4 % in the control group (p < 0.001). Favorable outcomes were observed in 84.4 % of laparoscopic surgery cases. Among the 112 patients who underwent open surgery, favorable outcomes were recorded in 70.5 % of cases. This confirms the relevance of limiting indications to complex clinical situations.

Conclusion. This differentiated treatment strategy, which considers the ultrasound structure of the cyst and its anatomical characteristics, ensures a personalized choice of treatment method while enabling consistently high recovery rates across various minimally invasive techniques.

Aim. To evaluate the feasibility of using circulating tumor DNA (ctDNA) to diagnose malignancy in cystic pancreatic tumors by comparing test results of plasma, cyst contents, and tumor tissue samples with clinical and morphological data.

Material and Methods. Specific markers in ctDNA were investigated in 32 patients with cystic pancreatic tumors. Prior to surgery, all patients underwent next generation sequencing (NGS) of ctDNA isolated from blood plasma. Cystic fluid aspirates and tumor tissue samples were additionally analyzed in 15 patients who underwent surgery.

Results. Mutations in the KRAS, GNAS, and ATM genes were detected in the plasma samples of five patients with histologically confirmed malignant cysts and clinical signs of malignancy. No mutations were found in the remaining patients. CtDNA was present in the contents of one cystic tumor. However, CA 19-9 levels remained within the normal range in all patients, including those with malignant tumors, which emphasizes the low sensitivity of the marker. A multivariate analysis revealed that the presence of ctDNA in blood plasma is a statistically significant predictor of malignancy (p < 0.001), which surpasses traditional risk factors. These results were then compared with data from the current literature and international guidelines.

Conclusion. Integrating molecular genetic testing methods into clinical practice optimizes the management of patients with cystic pancreatic tumors. This approach allows for a more personalized assessment of the risk of malignancy thus enabling the timely development of an appropriate treatment plan.

Aim. To examine the immediate outcomes of pancreatic duct stenting in cases of pancreatic necrosis and to identify potential factors that may reduce the effectiveness of the procedure.

Materials and Methods. A retrospective pilot study was conducted to evaluate the outcomes of endoscopic transpapillary stenting of the pancreatic duct in 77 patients with severe acute pancreatitis. The efficacy of the procedure was assessed by monitoring the dynamics of peripancreatic inflammation, organ dysfunction, infection development, and patient mortality.

Results. No complications arose during endoscopic transpapillary procedures. The progression of parapancreatitis was observed in 29 patients following stenting: early organ failure in 18 patients and infection in 19; 6 patients died. A regression in parapancreatitis was observed in 33 patients: 7 had organ failure and 12 had infection (p < 0.05 compared with the previous group); no deaths occurred. In 15 patients, no dynamics of parapancreatitis were observed. The most significant results were obtained in 25 patients with Type I pancreatic necrosis. In 11 of these patients, the distal segment of the 87.3 ± 6.7 mm stent was located in the duct of viable parenchyma beyond the necrosis zone. A regression in parapancreatitis was observed, dropping from an average of 5.45 ± 0.92 points to 2.90 ± 0.47 points (p < 0.023). No cases of early organ dysfunction or fatalities occurred. In 14 patients, the distal segment of the stent (65/0 ± 4.9 mm in length; p < 0.05) remained in the duct within the necrotic zone. Parapancreatitis did not improve (4.93 ± 0.85 vs. 6.36 ± 0.77; p = 0.22), five patients developed organ failure (p = 0.0267), and three patients died.

Conclusion. The role of parapancreatitis progression in the development of early organ failure has been established. The feasibility, efficacy, and safety of recanalization of the pancreatic duct through an area of Type I pancreatic necrosis have been demonstrated. The CT scan results must be available before the endoscopic procedure. A sufficiently long stent must be used to drain the duct beyond the necrotic area and into the viable glandular parenchyma. It is not advisable to stent the duct without reaching viable parenchyma, as this does not lead to resolution of parapancreatitis or improved treatment outcomes.

Aim. To estimate the healing time for true external pancreatic fistulas that develop after the drainage of pancreatic pseudocysts, and to identify the factors that affect their closure.

Materials and Methods. In a retrospective analysis, the treatment of 132 patients with post-necrotic pancreatic cysts was examined. The patients underwent external drainage under ultrasound guidance. Of these, 114 patients developed Grade B external pancreatic fistula, and 18 developed Grade C fistula. The study evaluated the healing times, recurrence rates, clinical success rates, and complication rates of these fistulas.

Results. In 89.4 % of patients, the external pancreatic fistula closed on its own (spontaneously) within six months after drainage. The average healing time was 113 ± 25 days. A fistula that persisted for more than six months was associated with a pseudocyst in the head or body of the pancreas that exceeded 10 cm in size, as well as transverse necrosis affecting more than 50 % of the parenchyma. A lasting positive outcome was achieved in the treatment of a persistent external fistula, with no recurrence of the pseudocyst, through isolated Roux-en-Y pancreatic reconstruction or Roux loop pancreaticojejunostomy.

Conclusion. In most patients, Grade B and C external pancreatic fistulas resulting from the external drainage of pancreatic pseudocysts close spontaneously within two to six months. However, spontaneous closure does not occur in cases involving extensive transverse pancreatic necrosis (>50 %) and/or damage to major ducts, including the pancreatic duct.

Protocols for enhanced recovery after surgery (ERAS) that have been proven effective in oncological surgery remain controversial when applied to pancreatoduodenal resection. An increasing number of research findings underscore positive outcomes associated with the ERAS approach to pancreatoduodenal resection. However, clinical practice commonly observes low adoption rates and significant variability in the application of individual protocol components. This review analyzes current data on the effectiveness of the ERAS concept in pancreatoduodenal resection. Barriers to implementing this concept in clinical practice are identified, and the reasons for the discrepancy between scientific evidence and clinical reality are examined. Data analysis reveals a 20–30% reduction in the incidence of complications and a 3–5-day shorter hospital stays when the concept of ERAS is fully implemented; although, only 12–15 % of medical facilities implement more than 80 % of the recommended components of the concept. The main barriers include organizational factors, insufficient resources, resistance to changing established practices, and the particularities of pancreatic surgery.

Aim. To evaluate the efficacy of multislice computed tomography (CT) in detecting the involvement of major afferent liver vessels by perihilar cholangiocarcinoma.

Materials and Methods. This retrospective study examined 40 patients diagnosed with perihilar cholangiocarcinoma between 2018 and 2024. All patients underwent multislice CT with intravenous contrast enhancement using a multiphase protocol that included the late arterial phase. Using circumference and length, the extent of tumor contact with the proper hepatic artery, the portal vein, and their branches was assessed. These parameters were evaluated individually and in combination. The analysis was performed separately for the proper hepatic artery and the portal vein. The data obtained were compared with the results of surgical intervention and morphological examination.

Results. Contact length between the tumor and the vessel wall > 11 mm or circumferential involvement ≥ 180° (encasement) were considered predictors of vascular involvement. Among patients who underwent surgery and histological examination, the rate of confirmed involvement was 53 % for the proper hepatic artery and its branches, and 69 % for the portal vein and its branches when using the combined criterion. The criterion of circumferential contact demonstrated the highest diagnostic accuracy for the proper hepatic artery and its branches, with a sensitivity of 100 % and a specificity of 84 %. The use of a combined criterion yielded high sensitivity, while specificity was minimal (74 %). For diagnosing involvement of the portal vein and its branches, the circumferential contact parameter showed the highest specificity (86 %) with insufficient sensitivity (71 %). Conversely, a combined approach to the portal vein and its branches yielded maximum sensitivity (92 %) along with a decrease in specificity to 36 %.

Conclusion. In CT imaging, the most informative marker of vascular involvement in perihilar cholangiocarcinoma is the degree of circumferential vessel encasement. The use of a combined criterion is advisable to reduce the rate of false-negative findings, particularly when assessing portal vein involvement.

This study reviews previous research on the outcomes of endoscopic treatment for patients with duodenal papillary adenomas, aiming to identify the causes and risk factors of the high incidence of complications. A total of 143 Russian and international publications from the past 15 years were reviewed, focusing on the short- and long-term outcomes after surgical or endoscopic treatment. Of these, 15 publications investigated the causes and risk factors of complications from endoscopic procedures for adenomas of the major duodenal papilla. The study revealed that ineffective preventive measures and a lack of standardized methodology are the primary reasons for the high incidence of complications, hindering the efficacy and safety of endoscopic treatment for this patient population.

This paper presents a clinical case report of a 46-year-old woman diagnosed with a hepatic tumor of the right lobe, which was complicated by tumor rupture and intra-abdominal hemorrhage. Complications from large hepatic tumors are life-threatening and therefore require a timely, comprehensive diagnosis followed by urgent surgical intervention. In this clinical case, due to the large size and poor mobility of the tumor in the right lobe of the liver, as well as its proximity to the diaphragm, the liver parenchyma was dissected after the vascular and secretory structures of the portal tract of the right lobe were isolated and transected, without prior mobilization of the right lobe. This was followed by right lobe mobilization and diaphragmatic resection. No complications were observed during the postoperative period. Data from the literature are presented. For large hepatic tumors with rupture and intra-abdominal hemorrhage, emergency surgery remains the only reliable and definitive treatment option.