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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. To compare survival after open liver resections and laparoscopic liver resection based on the experience of two large Russian surgical centers using the propensity score matching. Material and methods. The primary point of the study was the assessment of long-term overall and disease-free survival after laparoscopic and open liver resection. The secondary point were immediate outcomes. Propensity score matching was used for balancing covariates and reducing the drawbacks of observational study. Results. The study included data from 185 patients after 93 laparoscopic liver resection and 92 open liver resection. The immediate outcomes of 176 patients (95%) were analyzed. Long-term results were evaluated in 157 patients (85%) with propensity score based analysis. Forty-three pairs were matched. The blood loss and the hospital stay were less in the group of laparoscopic liver resection before matching. After matching, the blood loss was equal in both groups. The length of hospital stay remained significantly shorter in laparoscopic liver resection group after matching. No differences in severe morbidity was observed between groups. No death was registered after open and laparoscopic liver resection. The overall 5-year survival rate in the laparoscopic and open liver resection groups did not differ before and after matching (56%/68% and 72%/76%, respectively). Disease-free 5- and 4-year survival did not differ either, but revealed the trend to be longer after laparoscopic liver resection before and after matching (52%/10% and 58%/28%, respectively). Conclusion. Laparoscopic liver resection for colorectal liver metastases reduced the hospital stay. The overall survival of patients did not depend on the type of approach. Disease-free survival discovered the trend to improve after laparoscopic liver resection.

Aim. To determine the indications for staged treatment in planning of advanced liver resections using SPECT. Material and methods. There were 26 patients for the period 2007–2016 who required advanced liver resections at the surgical clinic of the Botkin Hospital. Anatomic FLR (aFLR) was less than 30% in all cases that is an indication for right portal branch embolization. Two-stage treatment has been applied in 15 patients (group 1) for the period 2007–2014. Preoperative examination has included SPECT since 2015. Indication for two-stage treatment was functioning FLR (fFLR) less than 30% (group 2). The second group included 11 patients. Results. In the first group (n = 15), all patients underwent right portal branch embolization. Nine of them underwent surgery including advanced right-sided hemihepatectomy in 5 cases and right-sided hemihepatectomy in 4 cases.Acute postoperative liver failure occurred in 1 (11.1%) patient (ISGLS class A). In the second group (n = 11) need for portal embolization was determined after SPECT. In 5 patients fFLR was over 30%. Thus, advanced right-sided hemihepatectomy and conventional right-sided hemihepatectomy were carried out in 2 and 3 cases, respectively. Six patients had fFLR less than 30% and two-stage approach was indicated. Five patients underwent radical surgery: advanced right-sided hemihepatectomy and conventional right-sided hemihepatectomy were carried out in 2 and 3 cases, respectively. There were no cases of acute postoperative liver failure and mortality in this group. Conclusion. Preoperative SPECT is able to predict high risk of acute postoperative liver failure after advanced liver resection. Therefore, certain measures for prevention of this complication may be considered.

Aim . To compare early and long-term outcomes of laparoscopic and robot-assisted liver resections with open procedures. Material and Methods. Retrospective case-control study was performed. Pseudo-randomization was used to compare homogeneous data. We have assessed survival in patients with various forms of cholangiocellular carcinoma and colorectal cancer metastases after minimally invasive liver resections. Results. For the period 2013–2017 two hundred and fifteen minimally invasive liver resections were performed including 49 robot-assisted and 166 laparoscopic ones. Malignant tumors were in 45% of cases, benign tumors – in 42%, parasitic neoplasms – in 13%. Early results of minimally invasive resections and 70 comparable open liver resections were compared. All procedures were carried out within the same period at one institution. Immediate results were significantly better after minimally invasive liver resections both before pseudo-randomization and after that. There were 60 pairs of patients after pseudo-randomization. In groups of minimally invasive and open resections blood loss was 396 (0–3400) and 853 (20–6000) ml respectively, time of surgery – 319 (85–580) and 376 (180–775) min, incidence of severe (Clavien–Dindo II and over) complications – 10% (n = 6) and 23% (n = 14), length of postoperative hospital-stay – 9 (3–90) and 12 (2–39) days, respectively. 3-year survival after mini-invasive liver resections for colorectal cancer metastases was 70%, various forms of cholangiocellular carcinoma – 40%. Conclusion. Conventional liver resections can be successfully performed in laparoscopic or robot-assisted fashion in certain patients at specialized center of surgical hepatology with sufficient experience in open and laparoscopic liver surgery.

It is presented a review of current and the most relevant materials including evidence-based researches, guidelines, devoted to anesthesia during extended liver resections. Present algorithms of anesthesia were analyzed based on these data. It was noted significant differences in anesthetic approaches which are mainly explained by the problem of massive intraoperative blood loss. Expanding practice of liver transplantation is making significant adjustments to the carrying out of anesthesia during surgical intervention. Optimal algorithm of anestesia is determined based on the experience of extended liver resections and transplantations.

Aim. To study the opportunities, immediate and long-term results of surgical treatment of locally advanced hepatic alveococcosis with invasion into great vessels. Material and Methods. The study included 63 patients. There were 19 liver transplantations, 12 normothermal liver autotransplantations (ante situm), 1 hypothermic liver autotransplantation (ex situ ex vivo) and 31 extended liver resections with resection and repair of great vessels. Results. Overall morbidity after liver transplantation was 31.6%, after normothermic liver autotransplantations — 38.5%, after extended liver resections with resection and repair of great vessels — 25.8%. Mortality after liver transplantation was 5.3% (1 patient). There was no in-hospital mortality after liver autotransplantations and after extended liver resections with resection and repair of great vessels. Maximal follow-up after liver transplantation was 54 months, after liver autotransplantations — 38 months, after extended liver resections with resection and repair of great vessels — 40 months. Long-term mortality was absent. Median survival was 21 months. Conclusion. Transplantation techniques in liver surgery can be recognized as an important and new surgical strategy in the treatment of unresectable hepatic alveolar echinococcosis. Excellent immediate and long-term results of radical surgery for locally advanced hepatic alveolar echinococcosis using transplantation technologies emphasize justification to concentrate these patients in highly specialized centers.

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 study adamethionin effect on liver failure course after extensive liver resection. Material and Methods . 538 patients after extensive liver resection were included into study. Adamethionin has been used in the main group (326 patients) postoperatively while in the control group (212 patients) hepatoprotective therapy was absent. Incidence and severity of liver failure as well as postoperative complications were analyzed. Results. Total incidence of post-resection liver failure was 23% (18.7% and 30.2% in the main and control groups respectively, p 0.05). Postoperative hospital-stay was 15 (12–28) days in the control group and 11 (9–19) days in the main group (p < 0.05). Conclusion. Liver failure is possible after extensive liver resections (over three segments). Ademetionin contributes to restoration of liver structure and function, reduces the incidence of liver failure and hospital-stay, provides faster recovery of residual liver parenchyma.

Aim. Combined evaluation of liver functional and volumetric reserves prior to advanced liver resections. Material and Methods. The study included 24 patients who underwent extended liver resections for the period 2013– 2016. Clinical and laboratory data, indocyanine green (ICG) clearance, CT volumetry, static polypositional hepatoscintigraphy were assessed in all cases. Results. Individual tests showed sufficient functional reserve of FLR in all patients. However in 7 (29.2%) cases advanced resections were refused in favor of less liver volume removal, two-stage surgery or portal vein embolization to increase remnant liver volume. The reasons for refusal were compiled simulation of extended resection using PET combined with scintigraphy and comprehensive analysis of all factors affecting postoperative liver failure. Conclusion. Comprehensive assessment of functional and volumetric reserve prevents postoperative liver failure. At present time transition from evaluation of total liver parenchyma reserves to isolated assessment of FLR reserve is the most actual problem.

Aim: to develop a new predictive method for post-resection liver failure prior to surgery and in early postoperative period. Material and Methods. Diagnostically significant risk factors for post-resection liver failure were determined based on 286 advanced liver resections. The prognostic scale was created taking into account prognostic significance of each parameter. International Study Group of Liver Surgery classification was used to assess quality of liver failure prediction. Results. It was defined the formula for calculation of liver failure incidence after hepatic resection. The probability of various classes of liver failure was received depending on the values of calculated criterion. Conclusion. Multi-factor modeling systems are perspective for prognosis of postoperative liver failure. Therefore curative tactics may be determined.

Aim. To clarify the indications for preoperative portal vein embolization using CT-volumetry and indocyanine green clearance as predictors of post-resection liver failure. Material and Methods. The results of 179 liver resections were analyzed. There were 128 hemihepatectomies and 51 partial resections. In 24 cases preoperative portal vein embolization was used. Indocyanine green clearance test was applied for a quantitative assessment of liver function. Plasma disappearance rate and residual concentration of indocyanine green during the first 15 minutes were determined. CT-volumetry was used to calculate the future remnant liver volume. Posthepatectomy liver failure severity was evaluated in accordance with the recommendations of the International Study Group of Liver Surgery (ISGLS) and taking into account “50–50" criteria. Results. The frequency of posthepatectomy liver failure after extensive resections was 42.5%: grade A – 38.7%; grade B –41.9%, grade C – 19.4%. The future remnant liver volume as a predictor of posthepatectomy liver failure had moderate predictive power (c-statistic = 0.71, p = 0.04) with sensitivity and specificity about 84.6% and 61%, respectively. Indocyanine green elimination was significantly worse in patients with chronic liver disease or after previous repeated courses of chemotherapy (plasma disappearance rate 15.6%/min vs 18.6%/min, p = 0.004; indocyanine green residual concentration after 15 minutes 19.6% vs 6,1%, p = 0.003). Clearance test with indocyanine green was characterized by high sensitivity (92.3%) and specificity (71.4%) in the definition of liver function and excellent predictive power (c-statistic = 0.82, p = 0.0001) in determining of posthepatectomy liver failure. Risk factors of posthepatectomy liver failure were future remnant liver volume 15%/min or plasma disappearance rate of indocyanine green >10%/min but

Aim. To estimate early and remote outcomes of portal vein embolization and ALPPS for prevention of post-hepatectomy liver failure. Material and Methods. 358 liver resections were performed for the period 2008–2016. There were 132 (36.9%) advanced resections (over 4 segments). Cholangiocelullar carcinoma was diagnosed in 48 cases (36.4%), hepatocellular carcinoma – in 23 (17.4%) cases, colorectal liver metastases – in 19 (14.4%), parasitic liver diseases (hydatid disease, alveococcosis) – in 31 (23.5%) cases and others – in 11 (8.3%) cases. Vascular resection was performed in 42 (31.8%) patients, common bile and (or) common hepatic duct resection – in 76 (57.6%) cases. In this article 41 cases of portal vein embolization with staged liver resection and 6 cases of ALPPS are described. Control group included 85 advanced liver resections without portal vein embolization. Results. Portal vein embolization was effective in 41 (66%) cases: FLR growth was 52% (33;61) within average terms of 5.0 (4.0; 6.5) weeks. In ALPPS FLR growth was 70% (60; 77) after 11 (7; 17) days, in 1 case it was uneffective (FLR% – 30% after 24 days). The grade B+C of post hepatectomy liver failure was observed in 66 (50%) cases, infectious complications – in 39 (29.5%) cases, biliary complications – in 29 (21.9%) cases, post hepatectomy bleeding (grade C, ISGLS) – in 5 (3,8%) cases. In-hospital mortality was 8,3 %. Portal vein embolization decreased grade C post hepatectomy liver failure (7.3% vs 20%) (p = 0.07). Conclusion. Two-stage liver resection with primary embolization or ligation of the portal vein can reduce the frequency of post-resection liver failure. For certain patients ALPPS is the only method that allows to perform radical surgery and preserve necessary amount of hepatic parenchyma. However long-term results are unpredictable