Aim. To identify the major clinical manifestations and assess current capabilities of laboratory and instrumental  dignostic methods for neuroendocrine tumors of the pancreas and gastrointestinal to justify the choice of surgical treatment.

Materials and Methods. Results of treatment of 202 patients with neuroendocrine tumors are presented. There were 124 patients  with pancreatic  tumors  and  78 patients  with tumors  of various parts of gastrointestinal  tract.  Diagnosis  of neuroendocrine tumors included laboratory confirmation of clinical neuroendocrine syndrome and topical diagnosis. Surgical treatment was applied  in 199 patients.  Long-term  results were studied  based on regression of clinical  and laboratory manifestations of neuroendocrine pathology and 5-year survival.

Results. Clinical  manifestations  of gastrointestinal  neuroendocrine tumors  are nonspecific  in 90% of patients  that extends the terms of diagnosis. The sensitivity of laboratory methods for diagnosis of pancreatic neuroendocrine tumors was 96%, for gstrointestinal tract – 92%. The most accessible methods of topical diagnosis of pancreatic neuroendocrine tumors  are CT and endoscopic  ultrasound  with sensitivity 75% and 91%, respectively. It is advisable to complement diagnosis by intraoperative  sonography.  Sensitivity of endoscopic  methods  of investigation (fibrogastroduodenoscopy, fibrocolonoscopy) in the diagnosis of gastrointestinal neuroendocrine tumors is 96.2%. PET with 18-fluorodeoxyglucose is an optional method  of detecting the tumoral process generalization.  Surgical treatment eliminated  the symptoms of neuroendocrine syndrome  and  provided  overall 5-year  survival of 69.3 ± 4.7% in radically  operated  patients  with pancreatic  neuroendocrine tumors and 63.0 ± 5.2% in patients with gastrointestinal neuroendocrine tumors.

Conclusion. Laboratory  and  instrumental  methods  confirm  clinical  neuroendocrine syndrome  and  localized  tumors in pancreas and different parts of gastrointestinal  tract. Surgical treatment can eliminate symptoms of neuroendocrine syndrome, improve 5-year survival and quality of life.

Aim. To reflect the main approaches and trends in neuroendocrine tumors imaging.

Materials and Methods. 255 patients  with hormonally  active pancreatic  neuroendocrine tumors  were examined  and operated   for  the  period  1990–2015.  There  were  insulinomas  predominantly.  Sensitivity  of  ultrasonography,  CT, endoscopic ultrasound, arterial-stimulated blood sampling, IOUS was analyzed to reveal changes in diagnostic algorithm for this period.

Results. Multiple  pancreatic  lesions occurred  in 30%. Over the 25 years endosonography  as new “gold” standard  for pancreatic visualization was introduced. Indications for arterial-stimulated blood sampling were narrowed. However, this method is still actual and effective in the most difficult diagnostic situations.

Conclusion. Accurate  preoperative  topical  diagnosis  allows to  offer optimal,  organ-sparing  procedure  and  reduce intraoperative  trauma of the pancreas and number of postoperative complications.

Aim. To assess possibilities of modern technologies in surgical treatment of pancreatic  insulinomas.

Material and Methods. 21 operations  for pancreatic  insulinoma  were performed.    Laparoscopic  and robot-assistant operations were applied in 10 and 11 cases respectively. 6 patients required conversion to laparotomy because of failure to determine insulinoma and need for manual palpation.

Results. There  were no  intraoperative   complications. Postoperative  mortality  was 0%.  The  most  of postoperative complications  were observed in patients after conversion to laparotomy.  Incidence  of complications  was minimal after robot-assistant  operations. Minimally invasive technologies were also successfully applied to treat complications.

Aim. To analyze the results of treatment of patients with pancreatic  malignant neuroendocrine tumors.

Materials and Methods. Since 2005 to 2014 period 49 patients with malignant neuroendocrine tumors were examined and treated.  76.6% patients  (n = 38) were treated  within 2010–2014  years. In 59.2% of cases liver metastatic  lesion occured.  Comprehensive  specific treatment with surgical resection  of primary tumor  site was used in 73.5% of cases (n  = 36).  Some  patients  received  perioperative  intraarterial   chemoembolization and  surgical  tumor  removal  was supplemented  by radiofrequency or microvave ablation of metastatic liver sites, anatomical  liver resections.

Results. Postoperative mortality was observed only after extended surgical resection (8.3%, (n = 3)). All patients with low differentiated tumors had histological signs of perineural invasion, abcence of therapeutical effect of specific treatment even after surgical resection of primary tumor site. In view of this long-term  survival was low. At present time most of surgically treated patients (85.2%, (n = 32)) with low and moderately differentiated neuroendocrine tumors live without signs of progression. Follow-up varies within 5–119 months.

Conclusion. Combined  treatment including aggressive surgical approach  and perioperative  intraarterial  chemoembolization is associated with good remote results in case of highly and moderately differentiated neuroendocrine tumors.

Aim. To determine the effectiveness of stereotaxic radiotherapy  in patients with liver metastases.

Material and Methods. Stereotaxic radiotherapy of liver metastatic tumors was carried out in three fractions for 5–8 days with single focal dose of 10, 12, 15, or 20 Gy. The procedure  was performed in 66 patients including 40 (60.5%) women and  26 (39.5%) men.  The  average age was 60 years (37–82). In  24 (36.5%) cases primary  tumor  was presented  by colorectal cancer, in 12 (18%) – breast cancer, in 7 (10.5%) – ovarian cancer and in 23 (35%) – other malignant tumors.

Results. Median  follow-up was 14.5 months  (range 1.8–53.5).  3 patients did not present data of control  examination. Among other 63 patients full effect was established in 16 (25.5%) cases, in 30 (47.5%) patients – partial regression of metastases,  in 11 (17.5%) – stabilization,  in 6 (9.5%) – progression of tumoral  process. Thus,  local control  rate was 90.5%. Degree III of radiation damage was reported in 2 cases (3%), II – in 7 cases (11%).

Aim. To improve the efficiency of treatment of advanced liver alveococcosis using modern surgical techniques including transplantation.

Material and Methods. It was analyzed surgical treatment of 25 patients with advanced liver alveococcosis for the period 2008–2014.  Operations  were performed  in  21 cases. Lung  metastasis  were diagnosed  in  two of them.  Long-term obstructive jaundice was observed in 5, portal hypertension  – in 2. 1 patient with associated HBV had liver cirrhosis.

Results. Surgical interventions  had extended volume and included liver resection “in situ” in 16 cases, orthotopic  liver transplantation (OLT) in 3 patients. Invasion into IVC was detected in 9 cases. In 6 patients IVA was made a prosthetic appliance using PTFE-prosthesis including 1 case with left hepatic vein orifice repair and 3 cases with partial resection. Resection and reconstruction of portal vein were required in 6 cases. 9 patients underwent resection of the extrahepatic bile ducts. Resection of the right dome of the diaphragm was made in 4 cases. In one case explorative laparotomy  was performed. All patients after surgery receive antiparasitic therapy. There was 1 death in the early postoperative period due to  multiple  organ  failure.  There  were  no  recurrences   within  7-year  follow-up.  Antiparasitic  therapy  after  liver transplantation did not require adjustment of immunosuppressive therapy.

Conclusion. Surgical interventions  for liver alveococcosis have advanced volume and are combined with reconstruction of great vessels and bile ducts. Maximum tendency to resection is caused by potential risk of immunosuppressive therapy after transplantation for the progression of the disease, that justifies difficult resections “ex situ”.

Aim. To assess double balloon enteroscopy for diagnostics and treatment of pancreatojejunostomy complications  after pancreatic  surgery.

Material  and Methods.  For   the  period  2010–2015   twenty  patients   with  suspected  disorders  in  the  area  of pancreatojejunostomy underwent  transoral (antegrade)  examination  of the pancreatojejunostomy using double balloon enteroscopy.

Results. Pancreatojejunostomy was examined  in  17 cases (85.0%).  There  were no  complications. In  the  11 cases postoperative  complications   of pancreatojejunostomy  were identified  including  stricture  and  failure  of pancreatojejunostomy, anastomotic  stricture of intrapancreatic bilioenteric anastomosis, residual stones in pancreatic duct. It was performed  9 minimally invasive operations  in the area of pancreatojejunostomy using double balloon enteroscopy and surgical laser. Herewith in 4 cases indications for open surgery were established.

Objective. For unsafe (seriously ill or debilitated)  and severe cholecystitis patients,  percutaneous cholecystostomy  with scheduled  interval cholecystectomy  (IC)  has been advocated;  however, because of lacking an inflammation grading system none of the published data comparing changes of inflammation status is available.

Background. Using a self-designed gallbladder (GB) inflammation grading system, the author tried to predict outcomes of IC and reappraise whether delayed IC is justified.

Methods. The intraoperative  inflammation of 260 consecutive laparoscopic cholecystectomy  (LC) patients with symptomatic  GB stone diseases was graded (I–VI). Based on grading criteria, predicted outcomes were categorized as “improve”, “unpredictable”, “no change”,  and “worsen”.

Results. Predictive results of these four categories for Grades I–III  (inflammation limited to GB) were 23.7, 2.5, 73.0, and  1.4%;  14.3,  57.1,  14.3,  and  14.3%;  7.7,  53.8,  7.7,  and  30.8% respectively.  For  Grade  IV (mild  to  moderate inflammation of Calot’s triangle) they were 11.5, 9.6, 30.8, and 50.0%. For Grades V (severe inflammation of Calot’s triangle) and VI (severe inflammation involving the hepatoduodenal ligament) they were 0, 0, 0, and 100%. All 3 common bile duct injuries were in the “worsen” category.

It is presented the review of the most relevant and evidentiary materials of the 5th Congress of A-HPBA. The works are devoted to optimal indications for mini-invasive treatment of HCC,  current possibilities of management of complicated HCC,  comparative  analysis of the results of laparoscopic  liver resections,  prognosis of primary  liver cancer  course, treatment of background liver diseases and questions of liver transplantation.

It is presented an effective treatment of rare abnormality namely isolated pancreatic head echinococcosis. In view of rare localization  for this disease, difficult availability for needle biopsy, uninformative  data of biopsy, difficult intraoperative diagnostics,  final diagnosis was determined  using elective histopathological  examination  of specimen  after pylorussparing  pancreatoduodenectomy.  Pre and  intraoperative   verifying of  diagnosis  would  allow  to  perform  adequate pancreatic  head resection in this particular case.

The article presents clinical case of successful treatment of patients with metachronous, resectable liver metastasis of colorectal cancer located in hepatic veins confluence. It is shown the results of consecutive chemotherapy and portal vein embolization    which reduced  metastasis  size and increased  the volume of the left liver lateral sector.  Readiness  for transplantation has allowed to perform radical R0-resection. We obtained satisfactory long-term  outcomes.

Cystous transformation of pancreatic  neuroendocrine tumor  (NET)  is rare. It is caused by development  of secondary hemorrhages and necroses in large tumors. Necroses in NET are colliquative and the results of local violation of blood supply in tumor.  One  of outcomes  of tumoral  necrosis  or hemorrhage  is formation  of cyst due  to  local action  of macrophages  who lysis the necrosis fabrics and blood clots. Such mechanism  of tumor  transformation specifies that predominantly nonfunctioning asymptomatic  NET of large sizes are exposed to necrosis and following cystic transformation. It is presented clinical case of cystic transformation of pancreatic NET in 53 years old woman who didn't have any specific complaints. Difficulties of preoperative diagnostics were caused by fact that the solid part of tumor was expressed by insignificant hypervascular parietal component.

It is presented the clinical observation of patient with cholangiocellular  cancer who underwent extensive liver resection despite critically low volume of remaining liver parenchyma. Two-stage treatment was applied that decreased symptoms of liver failure in postoperative period.

The  article  describes  the  patient  with  pancreatic  cancer,  calculous  pancreatitis  and  diabetes  mellitus.  The  patient underwent  pancreatoduodenectomy followed by longitudinal  pancreatojejunostomy. Surgery resulted improvement  of diabetes mellitus.

It  is presented  clinical  observation  of cystic dilatation  of the  intrahepatic bile ducts  complicated  by obstruction  of confluence  and  liver right lobe duct.  Literature  review, difficulties of preoperative  and  intraoperative  diagnosis and nonstandard surgical treatment in patient with severe obesity are presented.

Aim. To systematize information  about levels of evidence of studies devoted to surgical pathology of spleen.

Material and Methods. Medical literature in various search systems was analyzed (PubMed search system, The Cochrane Library, academic electronic library eLibrary.ru) using the following keywords: spleen diseases, hyposplenism, hypersplenism, abscess, cyst, echinococcus, parasitic cyst, spleen trauma, spleen rupture, non-surgical treatment. The search results were correlated with ICD-10 according to evidence-based  value.

Results. Analysis included 36 publications,  including 6 literature  overviews with meta-analysis,  12 prospective studies and 18 retrospective studies. Evidence was found that preservation of spleen tissue with arterial blood supply rather than autotransplantation prevents development  of postsplenectomy  hyposplenism. Conservative tactics in spleen pathology benefits  from  endovascular  blood  circulation   reduction, radiofrequency   ablation  and  minimally  invasive  surgery. Vaccination prior to splenectomy and preventive antibiotic therapy after splenectomy reduce the lifetime risk of peracute infection. Non-surgical treatment of damage is a standard maneuver.