Liver-First Approach for Synchronous Colorectal Metastases: Analysis of 7360 Patients from the LiverMetSurvey Registry

Annals of Surgical Oncology - The liver-first approach in patients with synchronous colorectal liver metastases (CRLM) has gained wide consensus but its role is still to be clarified. We aimed to...     

Surgical policy in patients with chronic calculous cholecystitis complicated by choledocholithiasis

Results of surgical treatment in 116 patients with chronic calculous cholecystitis complicated by choledocholithiasis were studied. Introduction in clinical practice of endoscopic papillosphincterotomy (EPST) and laparoscopic cholecystectomy changed surgical policy for benign combined lesions of gall bladder and extrahepatic bile ducts. Complex endoscopic treatment is preferable if contraindications are absent. Complex endoscopic treatment was used in 26.7% cases, combined surgical and endoscopic (trans-papillar surgeries) - in 30.2%, conventional surgical - in 33.6%. Isolated EPST and endo-biliary procedures were performed in 9.5% patients. Complex endoscopic treatment is preferable for chronic calculous cholecystitis complicated with choledocholithiasis. Combined and conventional surgical policy is indicated when appliance of endoscopic technologies is not possible.     

Methodology of clinical studies in surgery

Results of clinical studies recently became the guidelines in decision making in medicine including surgical practice. Results of each study could be used generally only if all methodological requirements are fulfilled. In this paper the principles of clinical studies design particularly in surgery and medical publications analysis are described and discussed.     

En bloc resection of abdominal aorta and paraaortic lymph node metastasis of sigmoid cancer

The surgical management of colorectal metastasis is becoming a widespread practice in oncology. Synchronous resection of metastasis together with invaded major vessels (aorta) is still considered an extremely aggressive procedure. We demonstrate that en bloc resection of invaded aorta and paraaortic lymph node metastasis can be safely performed. The literature from experiences with similar techniques is also discussed.     

The treatment of the sponateneous biloma and choledocholithiasis after the liver resection on the reason of the giant hemangioma

Patient with giant rapidly growing liver hemangioma who carried out right hemihepatectomy is reported. The feature if this case is choledocholithiasis after liver resection followed by its rare complication (spontaneous biloma) in 6 years after surgery. Minimally invasive procedures (percutaneous drainage, endoscopic papillotomy and stenting) eliminated each of bile collection and cause of biliary obstruction without surgical intervention.     

The colorectal cancer progression after the right branch of vena porta occlusion

Liver resections by metastatic colorectal cancer are considered to be seldom applicable on the reason of bilobar lesions and insufficient volume of the left liver lobe. The two-stage operations have been suggested for such situations. Of 276 patients, treated in our centre, 52 cases, unsuitable for the single-stage liver resection according to the preoperative data, had been retrospectively chosen. All these patients had the procedure of the right branch of vena porta occlusion, which aimed the compensatory hypertrophy of the left liver lobe. The efficacy of the occlusion was up to 73%. The median left lobe enlargement was 11%. The increase of the summary diameter of metastases was 60,4% (from 53 mm to 85 mm; p < 0,0001). The follow-up time was from 3 to 96 months. The three-year survival time was significantly higher in patients with the completed two-stage surgical treatment in comparison with those, who were refused the liver resection--77 and 43%, respectively. The multifactorial analysis revealed the only independent factor of the survival time--the extrahepatic intraabdominal lesion (p = 0,014).     

Results of surgical treatment of benign strictures of extrahepatic bile ducts

The main reason of benign biliary strictures is the traumatic bile duct injuries during laparoscopic or open cholecystectomy. Although there are growing possibilities of interventional endoscopic treatment of such pathology the definitive operative drainage is in many cases the therapy of choice. There were analyzed the short- and long-term results of surgical reconstruction in 160 patients with of benign strictures of hepaticocholedochus. Complication rate was 12,5%, mortality 2,5%. Median follow-up period was 53,6+/-51,3 month, good and satisfactory long-term results were observed in 76%. There were revealed two factors, predicting poor outcome: biliary fistula (R=0,31; p=0,0053) and reoperations (R=0,309; small er, Cyrillic=0,0058). Conclusion: biliodigestive anastomosis is method of choice for treatment of benign biliary strictures of hepaticocholedochus. Hepaticojejunostomy with Roux-en-jejunal limb is more preferable variant of reconstruction for treatment of benign biliary strictures of HC. Good long-term results can be achieved in most part of the patients. In patient with not wide bile ducts and in technically difficult cases transhepatic biliary drainage is acceptable.