Risk adjustment of patient selection and technique in ALPPS resulted in a continuous drop of early mortality and major postoperative morbidity, which has meanwhile reached standard outcome measures accepted for major liver surgery.

Background. ALPPS is found to increase the resectability of primary and secondary liver malignancy at the advanced stage. The aim of the study was to verify the surgical and oncological outcome of ALPPS for intrahepatic cholangiocarcinoma (ICC). Methods. The study cohort was based on the ALPPS registry with patients from 31 international centers between August 2009 and January 2018. Propensity score matched patients receiving chemotherapy only were selected from the SEER database as controls for the survival analysis.

Objectives: To analyze long-term oncological outcome along with prognostic risk factors in a large cohort of patients with colorectal liver metastases (CRLM) undergoing ALPPS. Background: ALPPS is a two-stage hepatectomy variant that increases resection rates and R0 resection rates in patients with primarily unresectable CRLM as evidenced in a recent randomized controlled trial. Long-term oncologic results, however, are lacking. Methods: Cases in- and outside the International ALPPS Registry were collected and completed by direct contacts to ALPPS centers to secure a comprehensive cohort. Overall, cancer-specific (CSS), and recurrence-free (RFS) survivals were analyzed along with independent risk factors using Cox-regression analysis. Results: The cohort included 510 patients from 22 ALPPS centers over a 10-year period. Ninety-day mortality was 4.9% and median overall survival, CSS, and RFS were 39, 42, and 15 months, respectively. The median follow-up time was 38 months (95% confidence interval 32–43 months). Multivariate analysis identified tumor-characteristics (primary T4, right colon), biological features (K/N-RAS status), and response to chemotherapy (Response Evaluation Criteria in Solid Tumors) as independent predictors of CSS. Traditional factors such as size of metastases, uni versus bilobar involvement, and liver-first approach were not predictive. When hepatic recurrences after ALPPS was amenable to surgical/ablative treatment, median CSS was significantly superior compared to chemotherapy alone (56 vs 30 months, P < 0.001). Conclusions: This large cohort provides the first evidence that patients with primarily unresectable CRLM treated by ALPPS have not only low perioperative mortality, but achieve appealing long-term oncologic outcome especially those with favorable tumor biology and good response to chemotherapy.

Background: Surgery is the most effective treatment option for neuroendocrine liver metastases (NELM). This study investigated the role of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) as a novel strategy in treatment of NELM.Methods: The International ALPPS Registry was reviewed to study patients who underwent ALPPS for NELM.Results: From 2010 to 2017, 954 ALPPS procedures from 135 international centers were recorded in the International ALPPS Registry. Of them, 24 (2.5%) were performed for NELM. Twenty-one patients entered the final analysis. Overall grade 3b morbidity was 9% after stage 1 and 27% after stage 2. Ninety-day mortality was 5%. R0 resection was achieved in 19 cases (90%) at stage 2. Median follow-up was 28 (19-48) months. Median disease free survival (DFS) was 17.3 (95% CI: 7.1-27.4) months, 1-year and 2-year DFS was 73.2% and 41.8%, respectively. Median overall survival (OS) was not reached. Oneyear and 2-year OS was 95.2% and 95.2%, respectively.Conclusions: ALPPS appears to be a suitable strategy for inclusion in the multimodal armamentarium of well-selected patients with neuroendocrine liver metastases. In light of the morbidity in this initial series and a high rate of disease-recurrence, the procedure should be taken with caution.

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The facial allotransplantation technique was first introduced to the general public in 2005. The definition of the face as a complex system of organs that perform social functions made possible the adaptation of this operation into clinical practice. The year 2010 was the starting point for initial research in the Russian Federation. Based on previous achievements and existing world experience in this field, facial allotransplantation was used for the first time in 2015 in St. Petersburg. The goal of this operation was to reconstruct a soldier’s central facial area after an electric burn; he was injured in the military line of duty. This article describes complications faced regarding the preparation for this operation, the issues encountered for facial tissue removal, as well as donor selection criteria. Each stage of the composite facial allotransplantation, complications that can occur during operation, milestone results, as well as the subsequent rehabilitation and immunosuppressive therapy during the 4-year patient observation period following surgery, including the description of a single episode of cell-humoral rejection of transplanted tissue, are described in detail. The experience gained from the first facial allotransplantation performed in Russia shows the possibility of using a new composite allograft to correct deformities in the central area of the face with the achievement of a successfully functioning and aesthetically pleasing result after the operation. After 4 years of dynamic observation and individual rehabilitation programs, the main goal of the facial transplantation, that is, social re-adaptation of the patient, was achieved.

The Russian consensus on exo - and endocrine pancreatic insufficiency after surgical treatment was prepared on the initiative of the Russian "Pancreatic Club" on the Delphi method. His goal was to clarify and consolidate the opinions of specialists on the most relevant issues of diagnosis and treatment of exo - and endocrine insufficiency after surgical interventions on the pancreas. An interdisciplinary approach is provided by the participation of leading gastroenterologists and surgeons.

The aim of the investigation was to assess the immediate and long-term results of the liver transplantation in patients with unresectable hepatic alveolar echinococcosis.Materials and Methods. 22 liver transplantations were performed in the Center for Surgery and Transplantology of the A.I. Burnazyan Federal Medical and Biophysical Center between January 2011 and December 2016 for unresectable liver disease. Liver segments (the right liver lobe in all cases) from living related donors were transplanted to 21 patients, a posmortal donor liver was transplanted to 1 female patient. 16 patients (72.7%) had parasitic invasion of the inferior vena cava. All operations were done in R0 variant. Reconstruction of the great vessels was performed by synthetic PTFE-conduits if autoplasty was not feasible.Results. The duration of surgery was 430 (390-480) min. The intraoperative blood loss amounted to 1,500 (1,300-2,200) ml, cold ischemia lasted 30 (25-45) min. The morbidity rate of postoperative complications made up 45.4%. Biliary complications (Grade A, B, ISGLS, 2011) prevailed. Mortality rate was equal to 4.5%. The length of postoperative hospital stay averaged out to 20 (15-23.5) bed days. Long-term survival rate comprised 100%. Maximal follow-up period was 58 months.Conclusion. Liver transplantation with resection and reconstruction of the great vessels, including resection of the inferior vena cava and even the right atrium, may be the only radical method of treating unresectable hepatic alveolar echinococcosis, making it possible to provide satisfactory immediate and long-term results of surgical treatment of the patients seemingly doomed to death. These interventions should be performed only in highly specialized centers with a developed program of surgical hepatology and liver transplantation.