The paper presents the development of liver resection methods; it is a brief description of the evolution of improvement and implementation of many scientists’, researchers’ and practical doctors’ ideas, mainly aimed at preventing severe complications, the most common and important of which are bleeding and bile leakage, leading to a series of irreversible consequences and patients death. All described methods originate from each, from simple to complex - from elementary crushing of the liver tissue with two fingers and ligation of tubular structures to compression clips and cryo-scalpel. In the XX century, due to developments in medical technologies and medical physics new contemporary methods of microwave coagulation, using plasma surgical units and radiofrequency generators appeared. Hemo- and cholestasis effects of each method have its own advantages and disadvantages, which are reflected in the presented review. So far, the choice of liver resection method, excluding the most complications of intra- and postoperative periods is a matter of the sole initiative of each hepatic surgeon. The problem of preventing the most frequent complications is related to the surgery method and requires further studies and improvements. The survey does not reflect our own technique developed for liver resection used for 10 years, which is presented for a patent registration and further publication with detailed description of this technique and the results of operations, both immediate and long term.
Aim. To list and review the combined treatment options in patients with locally advanced metastatic renal cell carcinoma with inoperable metastases to retroperitoneal lymph nodes based on the results of diagnosis and treatment of two patients. Methods. Patients underwent primary tumor resection with further immunotherapy in first case and further immunoradiotherapy in second case. Results. The results of locally advanced metastatic renal cell carcinoma successful treatment are presented. Patient U., aged 73 years was admitted to the oncology department with Karnofsky performance-status score of 50-60 points. The diagnosis of right kidney cancer was set up in 2008, but the patient has refused surgery. At the end of 2011 after general status worsening she was hospitalized for planned surgery. Upper and medium midline laparotomy was performed using the general anesthesia. Enlarged right kidney in retroperitoneum and a batch of paraaortic and paracaval metastatic lymph nodes 13-15 cm in diameter were found at revision, right kidney was substituted by tumor tissue with areas of normal kidney parenchyma at the upper kidney pole, the tumor diameter was 10 cm. Renal artery and vein were gradually separated out of lymph nodes batch with a lot of technical difficulties and stitched and tied up. The specimen was removed as a whole together with paranephric tissues. Post-surgical treatment was complicated by an endogenous intoxication. Immunotherapy with intramuscular oxodihydroacridinylacetate sodium 500 mg every 48 hours i/m could only be started in a month after the surgery. Nowadays the patient is alive and continuing the treatment with oxodihydroacridinylacetate sodium, that induced the clinical improvement and reduced the size of the rest of the affected lymph nodes. Patient K. aged 50 years was admitted by ambulance with the same diagnosis as the first patient, and was treated using the same principles with an addition of radiotherapy. The overall patient’s condition improved after the treatment, there was a reduction of low back pain intensity and reduction of paraaortic and paracaval metastatic lymph nodes aggregate on palpation. Conclusion. Primary tumor resection in presence of inoperable metastatic retroperitoneal lymph nodes with further immunotherapy and radiotherapy can lead to clinical improvement and increase of the patient’s life duration.
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