Репозиторий Университета

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. To improve diagnostics and effectiveness of treatment in patients with unresectable cholangiocarcinoma complicated by obstructive jaundice. Materials and methods. A total of 28 patients (100%) with unresectable or functionally inoperable cholangiocarcinomas complicated by obstructive jaundice were diagnosed and treated. All patients underwent percutaneous drainage of the ducts under the ultrasound control and fluoroscopy. After reduction of jaundice video fluorescent diagnostic was performed. There was used a special module for that, by means of which a video fluorescent image of the bile ducts tumor was obtained and the degree of photosensitizer accumulation in the tissues was determined. Following photosensitizers were used: Photosens, Radachlorin (Russia) and Photolon (Belorussia). After the videofluorescence diagnostics photodynamic therapy of tumor stricture was conducted. Photodynamic therapy was performed using a fiber-optic system, if necessary, a controllable balloon catheter on the distal segment was used allowing to conduct therapy throughout the stricture more evenly. For the restoration of biliary evacuation nitinol stents were used. Results. In all patients a videofluorescent image of the bile duct tumor was obtained and a high degree of photosensitizer accumulation was determined. At the same time 23 patients (82%) had a malignant lesion confirmed morphologically. The effectiveness of combined treatment in unresectable cholangiocarcinoma was evaluated by life expectancy, the highest was 29 months (mean 14±5 months), but some of patients were under dynamic control for a period of 6 to 17 months. Conclusions. Usage of interventional treatment methods for patients with cholangiocarcinoma complicated by obstructive jaundice improves liver function and decreases jaundice. The combined use of minimally invasive technologies with fluorescent diagnostics and photodynamic therapy allows to increase the median life expectancy and improve the quality of patient’s life.

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.

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.

© 2018 Stavropol State Medical University. All Rights Reserved. The review presents the latest achievements in the field of complex adjuvant treatment of patients with portal cholangiocarcinoma. Modern data on the clinical efficacy and benefits of intraduct photodynamic therapy are presented.