[Long-term results of surgical treatment of intrahepatic cholangiocarcinoma]. / Otdalennye rezul'taty khirurgicheskogo lecheniya vnutripechenochnogo kholangiotsellyulyarnogo raka.

OBJECTIVE: To evaluate the long-term outcomes of surgical treatment of intrahepatic cholangiocarcinoma depending tumor dimensions, vascular invasion, lymph node metastases, cellular differentiation and quality of resection. MATERIAL AND METHODS: There were 46 patients with intrahepatic cholangiocellular cancer. Extended hemihepatectomy was made in 14 patients (30.4%), resection of two and three liver segments - in 17 cases (36.9%), standard hemihepatectomy - in 15 patients (32.6%). Liver resection was combined with extrahepatic bile duct resection in 5 (10.9%) patients. Liver resection was followed by biopsy of specimens. Dimension and number of tumors, differentiation grade, resection margin, liver capsule invasion, vascular invasion and regional lymph node metastases were analyzed. Forty-four (95.6%) patients were followed-up in long-term postoperative period. Statistical analysis was performed using Statistica 13.2 (Dell Inc., USA) and IBM SPSS Statistics v.25 (IBM Corp., USA) software package. Survival was analyzed using the Kaplan-Meier method. Overall 1-, 3- and 5-year survival rates with two-sided 95% confidence intervals (95% CI) were calculated using IBM SPSS Statistics v.25 software. RESULTS: Median survival was 37 months, 1-year - 75.9% (60.9-90.9%), 3-year - 57.6% (35.5-79.6%), 5-year - 36% (8.2-63.7%). Median survival after R1 resection was 37 months, R2 resection - 12 months. Median survival was not achieved in R0 group. We found significant differences in overall survival depending on quality of resection. Tumor dimension over 5 cm, low-grade adenocarcinoma, microvascular invasion and lymph node metastases were associated with impaired postoperative survival. However, differences were not significant. CONCLUSION: The main surgical strategy in patients with intrahepatic cholangiocarcinoma should be ensuring microscopically negative resection margin.

[Surgical anatomy of liver segment iv and its importance in hepatobiliary surgery]. / Khirurgicheskaia anatomiia iv segmenta pecheni i ee znachenie v gepatobiliarnoi khirurgii.

The purpose of this article was to describe clinical anatomy of liver segment IV and determine its significance in liver resection surgery and within integrated approach in the treatment of malignancies of this area.

[Current criteria for the diagnosis of adrenocortical carcinoma]. / Sovremennye kriterii diagnostiki adrenokortikal'nogo raka.

Adrenocortical carcinoma is a rare malignant tumor of the adrenal cortex with an unfavorable prognosis. In 2017, the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) published the 4th edition of the WHO Classification of Tumors of Endocrine Organs. The updated classification reflects a multidisciplinary experience in diagnosing and predicting the course of adrenal cortex tumors, obtained on the basis of current studies. This paper highlights the key provisions of the updated WHO classification for adrenocortical carcinoma.

[Predictors of outcomes in surgery for hilar cholangiocarcinoma]. / Prognosticheskie faktory rezul'tatov khirurgicheskogo lecheniia vorotnoi kholangiokartsinomy.

AIM: To determine significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma. MATERIAL AND METHODS: Analysis included 49 out of 84 patients who were operated at the Vishnevsky Institute of Surgery in 2003-2016. Morphological examination (2011-2016) revealed great percentage of following positive variables: micro- (42.9%) and lymphovascular invasion (11.8%), positive resection margin (59.2%), perineural invasion (83.3%), depth of invasion - (83.3%), cells in surrounding fatty tissue (92.3%), invasion of entire thickness of bile ducts' walls (57.1%). Hemihepatectomy was carried out in 50 (59.5%) cases, advanced hemihepatectomy - in 16 (19%) patients. Left-sided hemihepatectomy (34.6%) was more common compared with right-sided hemihepatectomy (8.6%) for biliary confluence lesion (Bismuth-Corlette type IV). RESULTS: TNM stage (p=0.29), tumor localization Bismuth-Corlette type (p=0.10), regional lymph nodes metastases (p=0.77) do not significantly affect survival in univariate analysis. At the same time, TNM stage was significant factor if patients dividing into groups was considered (p=0.05). In regression analysis tumor cells differentiation (p=0.00028), positive resection margin (p=0.0034), perineural invasion and depth of invasion (p=0,00086) were significant predictors of survival. Multivariate analysis confirmed prognostic role of lymphovascular invasion alone (p=0.05). There was no correlation between survival and TNM stage (η=0.057), depth of invasion (η= -0.229) and lymphovascular invasion (η= -0.143645). There was significant reverse moderate correlation between survival and perineural invasion (η= - 0.468750), resection margin (η= -0.558) and tumor differentiation grade (η= -0.481). CONCLUSION: Significant predictors of long-term outcomes of surgery for portal cholangiocarcinoma are TNM stage, lymphovascular invasion, tumor cells differentiation, perineural invasion.

[New criteria of radical surgery and long-term outcomes of hilar cholangiocarcinoma management]. / Novye kriterii radikal'nosti operatsii i otdalennye rezul'taty lecheniia vorotnoi kholangiokartsinomy.

AIM: To develop new criteria of radical surgery for hilar cholangiocarcinoma (HCC). MATERIAL AND METHODS: There were 165 HCC patients who underwent surgery in 1986-2016 at the Vishnevsky Institute of Surgery. TNM stage distribution: stage I - 4 (2.4%), II - 45 (27.3%) (29 of them are referred to the 1st period of work), IIIA - 23 (13.9%), IIIB - 41 (24.8%), IVA - 35 (21.2%), IVB - 17 (10.3%). 80 (48%) patients underwent hemihepatectomy, 17 (10%) - advanced hemihepatectomy, 16 (10%) - minor liver resection with common bile duct repair, 52 (32%) - common bile duct repair resection. Kaplan-Meier survival analysis was performed. Cox proportional hazard model was applied to access relationship between survival and prognostic factors. Log-rank test was used to compare both survival curves. RESULTS: R0-resection as followed by 5-year survival rate near 32%. Microvascular invasion was observed in 42.9%, lymphovascular invasion - in 88.2%, positive resection margin - in 59.2%, perineural invasion - in 83.3%, cells in surrounding fatty tissue were revealed in 92.3%. Resection may be considered radical (R0) if all variables are absent, 5-7 negative factors are followed by conditionally radical procedure (R+number of positive factors). Long-term outcomes and significance of new criteria were accessed (p=0.004). CONCLUSION: New criteria of radical procedure are presented. The last reflects the concept of dependence of 'pure' surgical edge from not only presence or absence of tumor cells in cut-off plane but also from important morphological features of tumor.

[Clinico-pathological factors and prognosis scale for portal cholangiocarcinoma]. / Kliniko-patologicheskie faktory i shkala prognoza pri vorotnoi kholangiokartsinome.

INTRODUCTION: The objective of this study was to derive a prognostic scale to predict overall survival (OS) after a curative resection of perihilar cholangiocarcinoma (PHC). MATERIAL AND METHODS: The data of 55 patients with portal cholangiocarcinoma were analysed. Patients were treated at the A.V. Vishnevsky Institute of Surgery from 2011 to 2015. Surgical treatment after biliary decompression was performed in 37 (67.3%) patients. In the long-term period we observed 36 (97.3%) of the operated patients. The dependence of the OS of clinical and pathological factors of the tumor was analysed using mono- and multifactor regression analysis of Cox proportional hazards models for all operated patients. RESULTS: Total 1-3-, 5-year survival rate was 75.1, 60.5, 37.7, 35% respectively. Significant prognostic factors (monofactorial analysis) include perineural (p=0,05) and vascular invasion (p=0,049), R1 resection (p=0,01), disease stage III or higher (p=0,03), invasion of SI liver (p=0,004), tumor cells differentiation degree (grade) 2 and higher (p=0,0006). Multifactor analysis revealed that the low OS have determined by perineural (p=0,05) and vascular invasion (p=0,008), the degree of differentiation of tumor cells (p=0,001), disease stage (p=0,05), surgical resection margin (p=0.0345). Developed method of predicting OS is a score of prognostic factors. CONCLUSION: The scale of individual prognosis in patients PHC takes into account both clinical and histopathological tumor characteristics. This scale may be useful to optimize the individual treatment.

[Mucinous cystic liver tumors: diagnosis and surgical treatment]. / Mutsinoznye kistoznye opukholi pecheni: diagnostika i khirurgicheskoe lechenie.

AIM: To optimize diagnostics and treatment of cystic liver tumors. MATERIAL AND METHODS: The analysis included outcomes of 46 patients with liver cystic tumors. RESULTS AND DISCUSSION: The use of abdominal Doppler-sonography (37 patients), abdominal contrast-enhanced CT (44 patients) and MRI of abdominal cavity with MR-cholangiography (24 patients) defined radiological semiotics of cystic liver diseases. The most important features of cystic tumors are intraluminal septums with blood flow (82% of patients), solid component (6.8%), daughterly cysts (11.3%), as well as biliary hypertension (39.2% of patients). Research of oncomarkers (CEA, SA 19-9, AFP) in 40 patients showed increased level of SA 19-9 only in case of cystadenocarcinoma and intraductal papillary mucinous neoplasm of biliary type. Benign and malignant cystic tumors had increased contents of oncomarkers in all cases. Surgical treatment was used in 42 patients. Extended liver resections were performed in 10 (23.8%) patients, atypical and anatomical resections (removal of less than 3 segments) - in 31 (73.8%) patients. In one case we applied cryoablation of CA in segment I of the liver in view of invasion into the wall of inferior vena cava and hepatoduodenal ligament. In 2 cases surgery was carried out laparoscopically. Also robot-assisted technique was used in 3 patients. Immunohistochemical study was performed in 22 (44.8%) patients. The diagnosis of CAC and biliary type of IPMN was confirmed in case of high expression of CK7, SK19, MUC1, S100p, SDH2, p53 antibodies. Cystadenomas were associated with moderate expression of ER, PR and p53 antibodies by stroma and CK7, SK19, CDX2, MUC1, S100p antibodies by epithelium. CONCLUSION: There are considerable difficulties of differential diagnosis of liver cystic tumors. Therefore, the use of single algorithm of diagnostics and treatment is necessary to confirm accurately the diagnosis at the perioperative stage. Cystic tumor is more likely to be assumed in women with solitary cyst in segment IV of liver. If the diagnosis is suspected or confirmed anatomical liver resection with complete tumor removal is necessary to prevent the recurrence.

In vivo dc and ac measurements at acupuncture points in healthy and unhealthy people.

OBJECTIVES: The aim of this work was to compare in vivo measurements of direct current (dc) and alternating current (ac) obtained from acupuncture points in Ukrainian and Mexican residents. METHODS: Measurements were made using the method of Voll. The participants were 43 healthy Ukrainian and 71 healthy Mexican residents aged between 20 and 30 years, as well as 24 Mexican patients with a clinical diagnosis of rheumatoid arthritis and 14 patients with a clinical diagnosis of allergy. RESULTS: The results showed that dc measurements are not directly applicable to different populations. Thus, the dc resistance of the acupuncture points in the Mexican participants was 4-5 times larger than in the Ukrainians. In contrast, the capacitance of the two groups did not differ by more than 25%. CONCLUSIONS: Impedance measurements from acupuncture points can be used as an efficient and prompt non-invasive method for diagnostic purposes.