Репозиторий Университета

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.