LONG-TERM RESULTS OF SURGICAL TREATMENT FOR PANCREATIC CANCER. A REVIEW OF THE LITERATURE

In recent decades, there is a trend towards growth and relatively high incidence of pancreatic cancer. Long-term results of surgical treatment remain unsatisfactory. However, in view of the progress of medical technology and the development of new surgical approaches to the treatment of pancreatic cancer, interest is the current state of the problem. This literature review focuses on the long-term outcomes of surgical treatment in patients with pancreatic cancer

Successful Surgical Treatment of “Complex” Abdominal Echinococcosis

Аim: to present the difficulties of surgical treatment of patients with multiple and combined echinococcal lesions. Key points. A 47-year-old patient who lived in Central Asia for up to 29 years of age was diagnosed with multiple echinococcosis of the abdominal cavity (CE1-2): II, Ivb, V, VI, VII segments of the liver, upper and lower poles of the spleen, lesser and greater omentum, small intestine, subphrenic space, area of the hepatoduodenal ligament, gastrocolic ligament. Surgical intervention was performed: atypical resection of liver segments V, VI, VII, subtotal pericystectomy, cholecystectomy, subtotal pericystectomy of cysts of II and IVb liver segments, subtotal pericystectomy of splenic cysts, resection of the greater omentum, echinococcectomy of the lesser omentum, mesentery of the small intestine, hepatoduodenal ligament, gastrocolic ligament, drainage of the abdominal cavity. Pericystectomy was carried out according to the technique of the National Medical Research Center of Surgery named after A. Vishnevsky.Conclusion. Due to the peculiarities of the course of helminthiasis and the pronounced variability of the lesion, it is extremely difficult to develop universal and effective treatment algorithms. The presented clinical observation demonstrates an example of the successful use of special surgical tactics for the treatment of “complex” echinococcosis of the abdominal cavity with good long-term follow-up results

Молекулярно-генетические аспекты внутрипеченочного холангиоцеллюлярного рака: обзор литературы

The modern concept of therapy for intrahepatic cholangiocarcinoma including surgical treatment, must take into account the achievements of molecular biology and modern staging principles. A detailed understanding of the molecular genetic (genetic and epigenetic) disorders underlying the pathogenesis of cholangiocarcinoma is important, which will improve the results of surgical treatment and expand the possibilities of personalized (targeted) therapy. Based on new data on cholangiocarcinogenesis, molecular profiling of bile duct tumors may be most appropriate for the selection of treatment in cases refractory to standard therapy. Current potential target therapy targets include endothelial growth factor receptors, fibroblast growth factor, MET tyrosine kinase, PI3K/Akt/mTOR signaling pathway and isocitrate dehydrogenase mutation. The review considers the molecular-genetic aspects underlying the pathogenesis and modern principles of staging intrahepatic cholangiocarcinoma.Современная концепция как терапии, так и хирургического лечения внутрипеченочного холангиоцеллюлярного рака должна учитывать достижения молекулярной биологии и современные принципы стадирования заболевания. Детальное понимание молекулярных (генетических и эпигенетических) нарушений, лежащих в основе патогенеза холангиокарциномы, позволит улучшить результаты хирургического лечения и расширит возможности персонализированной (таргетной) терапии. Основанное на новых данных о холангиоканцерогенезе молекулярное профилирование опухолей желчных протоков может быть наиболее целесообразным для подбора лечения в случаях, рефрактерных к стандартной терапии. Современные потенциальные мишени таргетной терапии включают рецепторы эндотелиального фактора роста, фактора роста фибробластов, MET тирозинкиназы, сигнальный путь PI3K/Akt/mTOR и мутации изоцитратдегидрогеназы. В обзоре рассматриваются молекулярно-генетические аспекты, лежащие в основе патогенеза, и современные принципы стадирования внутрипеченочного холангиоцеллюлярного рака

Diagnostic and Treatment Errors in Biliary Cystadenomas and Cystadenocarcinomas: Clinical Cases

Background. Biliary cystadenomas and cystadenocarcinomas are rare cystic tumors of the liver. Complicated differential diagnostics for simple cysts often leads to errors in surveillance of patients with these tumors. Cystadenoma and cystadenocarcinoma should be suspected upon detection of single or multilocular cystic neoplasms of the liver with septa and blood flow loci  in the cyst wall, especially in middle-aged women. The localization of the tumor is critical. The most common localization is segment IV of the liver. Urgent intraoperative biopsy is required to determine the extent of surgery.Case description. Clinical observations with analysis of the examination and treatment data of two female patients aged 38 and 56 were presented. Both clinical observations illustrate the underestimation of the preoperative examination data that served as a ground for diagnosis of liver cysts with inadequate extent of surgery. In the first case, the resection was incomplete, and, as such, the biliary cystadenoma recurred in the resection area, the capsule of the neoplasm was ruptured and an encysted fluid collection was formed. In the second case, lack of histological examination of the excised neoplasm, due to confidence in its morphological verification as a cyst, resulted in cystadenoma recurrence in the resection zone with metastasis to the contralateral lobe of the liver.Conclusion. Hepatic cystadenomas and cystadenocarcinomas are often misdiagnosed as simple cysts. These tumors should be suspected in central localization of the tumor in the liver, especially in young women. The clinical and instrumental symptomatology and radiological semiotics of the disease require careful evaluation. The recurrence of a cystic lesion in the resection zone in a patient previously operated for a hepatic cyst serves as an additional signal for detecting biliary cystadenoma. Rational strategy for surgical management of cystic liver lesions should include hepatectomy within healthy tissues (both anatomical and atypical) with mandatory intraoperative ultrasound and urgent histological examinations

Organization and management of patients with combined injuries in adygeya regional clinical hospital

Purpose - to estimate the effect of the order of the Ministry of health of the Russian Federation of december 15, 2009 № 991n. the level of mortality of patients with associated trauma in Adygei Republican Clinical Hospital (ARCB) before and after its implementation. After the implementation of this order affected mortality decreased from 14.6% to 10.1%. There are several negative aspects that must be considered in the future of medical care with associated trauma

DETERMINATION OF THE OPTIMAL METHOD OF TREATMENT OF PATIENTS WITH ACUTE DESTRUCTIVE PANCREATITIS

Currently, the question remains as to the appropriateness of percutaneous puncture-drainage, endoscopic and traditional surgery for acute destructive pancreatitis. The purpose of the work was to determine the management of patients, depending on ultrasonography and computed tomography of pathological changes of the pancreas The clinic treated 429 patients with acute pancreatitis. Of these destructive pancreatitis occurred in 96 (22,34 %) patients. 83 (86,46 %) patients underwent minimally invasive interventions (puncture and drainage under ultrasound navigation, laparoscopic drainage). The remaining 13 (13,54 %) patients underwent traditional intervention. The frequency of deaths was significantly lower in the group of patients with acute pancreatitis who underwent minimally invasive surgery. Selection surgical method in destructive pancreatitis should be determined on the basis of pathological changes to the pancreas and the surrounding tissue, detectable by ultrasound and computed tomography study. Optimal methods for the presence of liquid components are minimally invasive interventions under ultrasound navigation and laparoscopy

Molecular genetic aspects of intrahepatic cholangiocarcinoma: literature review

The modern concept of therapy for intrahepatic cholangiocarcinoma including surgical treatment, must take into account the achievements of molecular biology and modern staging principles. A detailed understanding of the molecular genetic (genetic and epigenetic) disorders underlying the pathogenesis of cholangiocarcinoma is important, which will improve the results of surgical treatment and expand the possibilities of personalized (targeted) therapy. Based on new data on cholangiocarcinogenesis, molecular profiling of bile duct tumors may be most appropriate for the selection of treatment in cases refractory to standard therapy. Current potential target therapy targets include endothelial growth factor receptors, fibroblast growth factor, MET tyrosine kinase, PI3K/Akt/mTOR signaling pathway and isocitrate dehydrogenase mutation. The review considers the molecular-genetic aspects underlying the pathogenesis and modern principles of staging intrahepatic cholangiocarcinoma

Frequency and effects of mutations in the KRAS gene on the survival of patients after surgical treatment of intrahepatic cholangiocarcinoma

Aim. To study the effect of mutations in the KRAS gene on the clinical course of intrahepatic cholangiocellular cancer (ICC) after surgical treatment in the Russian population.Materials and methods. A molecular genetic study of tumour tissue samples from 33 patients with intrahepatic cholangiocellular cancer obtained after surgical treatment was carried out using real-time polymerase chain reaction.Results. In the Russian population, the frequency of mutations in the KRAS gene in ICC was 27%, mainly in 12 (78%), 13 (33%), 61 (55%), 117 (44%) and 146 (44%) codons of 2, 3, 4 exons. In terms of KRAS gene mutations, intrahepatic cholangiocellular cancer is characterised by a pronounced heterogeneity. As a rule, the KRAS gene demonstrates multiple mutations at several loci and co-mutations in other genes, in particular, in IDH1/IDH2, PIK3CA, NRAS and BRAF genes. KRAS gene mutations in ICC were found to be significantly more common in women. The overall survival rate was significantly higher in patients with a KRAS mutation as compared to those with the wild type of the gene. Regarding the relapse-free survival rate in the groups of patients with the mutant and wild type of the KRAS gene, no significant differences were found.Conclusion. In the Russian population, no negative association between mutations in the KRAS gene and clinical outcomes was observed