[Synchronous operations in metastatic cancer of the liver].

The resection of the liver has been performed in 661 patients including 154 (23.3%) cases of synchronous metastatic cancer of the liver. Among the latter patients primary tumor was removed in one stage with liver resection in 56% cases. Elderly age of the patients, multiple bilobular foci in the liver, size of the foci more than 10 cm, traumatic operations on the primary focus were not contraindications to synchronous operations. Surgical treatment for colorectal cancer should be supplemented with adjuvant chemotherapy. The long-term results demonstrate better survival after synchronous operations for colorectal cancer.

[Surgical treatment of endocrine-cell tumors of hepato-pancreatic-duodenal zone (comment of the editor)]. / Khirurgicheskoe lechenie éndokrinno-kletochnykh opukholei gepatopankreatoduodenal'noi zony (kommentarii redkollegii).

Endocrine-cell tumors of hepatopancreatoduodenal zone are rare diseases. Their rate doesn't exceed 1-4% of all tumors of this location. 79 patients with endocrine-cell tumors of hepatopancreatoduodenal zone were treated, 67 of them underwent surgical treatment (operability was 67.1%) Radical operations were performed in 45 patients (gastropancreatoduodenal resection--17, distal resection of the pancreas--16, tumor enucleation--5, hemihepatectomy--3, liver resection--4). Prognosis of endocrine-cell tumors of hepatopancreatoduodenal zone is relatively favorable. In radically operated patients the presence of metastases to lymph nodes doesn't influence long-term results which are better than ones of chemo- or radiotherapy. Correlation between long-term results of surgery and age of patients, tumor sizes and its histologic structure was not revealed. Radicality of surgery is the only factor influencing prognosis. It is necessary to expand indications for extended operations, and to perform multi-stage operations in some cases of recurrences.

[Ultrastructural phenotypes of tumor cells of endocrine-cellular neoplasms of hepatopancreatoduodenal organs and their role in determining the degree of malignancy and prognosis of these diseases]. / Ul'trastrukturnye fenotipy opukholevykh kletok éndokrinno-kletochnykh novoobrazovanii organov gepatopankreatoduodenal'noi zony i ikh znachenie v opredelenii stepeni zlokachestvennosti i prognoza étikh zabolevanii.

78 tumors of the hepatopancreoduodenal system were studied clinically, cytologically and ultrastructurally. Hormonal disturbances were observed in 36% of the patients. The 5-year survival after radical surgery did not depend on the tumor size, tumor cell atypia or metastases to the regional lymph nodes. The prognosis was worse when the tumor was located in the liver. Ultrastructural features of the tumor cells were reliable criteria of the malignancy degree and tumor prognosis. The prognosis, recurrence-free interval and survival improve with an increase in the number of ultrastructurally differentiated cells and organoids in cytoplasm, and with a reduction in nuclear polymorphism and number of dark cells. The degree of histologic and ultrastructural differentiation of tumor cells may not coincide.

[Extended gastropancreatoduodenal resection (GPDR)]. / Rashirennaia gastropankreatoduodenal'naia rezektsiia.

The authors for the first time in Russia have begun serial performance of the extended GPDR. The operations were accompanied by careful morphological investigations of the removed organs and tissues. It was established that in all patients with exocrine cancer of head of the pancreas the tumor growth extended the region of the regional lymph nodes, i.e. standard GPDR in these patients oncologically could not be considered as adequate operation. Further performance of GPDR for pancreatic head exocrine cancer will expand knowledge about metastatic spread and will open opportunities to improve long-term survival of the patients with exocrine cancer of the head of the pancreas.

[Hepatopancreatoduodenal resection in locally advanced cancer of gallbladder]. / Gepatopankreatoduodenal'naia rezektsiia pri mestnorasprostranennom rake zhelchnogo puzyria.

A case of hepatopancreatoduodenectomy in advanced cancer of the gall bladder is presented as well as literature data on indications for this operation, technical peculiarities of its performance, postoperative complications, follow up results and advisability of carrying out such a complicated surgical intervention.

[Current approaches to surgical treatment of liver tumors]. / Sovremennye podkhody k khirurgicheskomu lecheniiu opukholei pecheni.

Since 1990, 230 operations for focal pathologies in the liver have been carried out at the Center's clinics using such advanced procedures and equipment as radio-isotope examination of hepatic function, ultrasonography of the liver during surgery, ultrasound aspirator, water-flow scalpel, argon coagulator and adhesive dressing materials. The study included 75 resections for primary hepatic tumor (lethality-14.6%), 114 resections-disseminated tumor (lethality-5.2%) and 41 resections for benign tumors and non-tumor pathologies (no lethality). Preoperative chemotherapy was found to significantly increase the risk of postoperative complications in cases of liver resection. Five-year survival in such patients with primary tumor was 33.3%. The seven most significant prognostic factors in primary hepatic carcinoma were: portal invasion by tumor cells, number of tumor nodes in the liver, alpha-fetoprotein concentration, tumor node size, concomitant cirrhosis, age and extent of surgery. In patients with hepatic resection for solitary metastasis of the large bowel, 5-year survival was 28.6%. A regimen of adjuvant chemotherapy for solitary metastasis of colorectal cancer into liver is suggested. The data on 37 surgical patients with hepatic metastasis of non-colorectal cancer are presented. It was demonstrated that the liver should be resected in cases of solitary metastasis of renal carcinoma, adrenal gland, ovary, tests, breast, gallbladder and carcinoid.