The questions of liver resection volume in patients with colorectal liver metastases are controversial and solved by specialists differently, taking into account the characteristics of the tumor lesion, the surgeon’s own experience and the technical capabilities of the clinic. On the basis of the abdominal department of Saint-Petersburg clinical scientific and practical center for specialized types of medical care (oncological) of N.P. Napalkov, we conducted a retrospective analysis of the long-term outcomes of 106 patients with colorectal liver metastases after extended (n=39) and minor (n=67) liver resections. The median of time-to-progression (TTP) was 8.0 months (95% CI 5.4–10.5) after extended and 11.2 months (95% CI 6.0-16.4) after minor liver resections. There was a tendency towards an increase in median overall survival (OS) for minor resections to 48.9 months (95% CI 31.5–66.4) compared with 33.4 months (95% CI 26.2–40.5) after extended resections. The rate of repeat resections in case of disease recurrence was higher in the minor resection group. When comparing the R0 and R1 resection groups, it was noted that the median OS was not significantly different (49.1 vs 40.8 months, 95% CI 25.7–72.5) despite an increase in TTP in patients with negative resection margins (10.8 vs 7.4 months, 95% CI 25.7–72.5). Thus, according to the analysis of long-term outcomes, no advantages were identified in performing minor interventions compared to extended liver resections, despite the obviously more unfavorable prognosis for massive metastatic liver disease.

Gastric cancer is an aggressive malignant neoplasm of the digestive system. These tumors are genetically heterogeneous,and they could be subdivided into four groups. One of such groups, microsatellite instable (MSI) gastric cancer, is of interest considering prognosis and response to therapy. Immune checkpoint inhibitors present a perspective strategy in treating these tumors, however, there is currently insufficient data on their use in microsatellite instable gastric cancer. Aim of this study was to evaluate objective response to neoadjuvant checkpoint inhibitors treatment in patients with MSI gastric cancer. Eleven patients were enrolled. They received Nivolumab or Pembrolizumab (investigator choice) in a neoadjuvant setting. Objective response was registered in 9 (81,8%) patients, two patients had stabilization. Nine patients (81,8%) underwent radical surgery. Pathologic complete response (pCR) was registered in 3 (33,3%). Postoperative complications were tracked and registered in accordance with Clavien-Dindo classification: grade 1 – 2 patients, grade 2 – 2 patients, grade 3 – 1 patient.

Purpose: To study the main risk factors of pancreatic fistula (POPF) after pancreatoduodenectomy (PD), in order to determine the degree of possible influence on them and reduce the development of early postoperative complications. Method: The results of examination and PD of 108 patients were studied from the period from 2016 to 2020. The criteria influencing the formation of POPF involved in the study: the consistency of the pancreas (determined subjectively according to the soft / hard), the diameter of the pancreatic duct, intraoperative blood loss, presence of biliary decompression (BD) before PD. Results: BD for the obstructive jaundice before PD were performed in 71 patients (65.7%), among them POPF developed in 17 patients (23.9%). In the group without BD (37 patients) in 9 (24.3 %) (p ˃ 0.05) .In patients with soft pancreas (50 patients), POPF developed in 21 patients (42.0%), among patients with hard pancreas - in 5 (5.8%) (p < 0.01). It was proposed to consider a diameter of up to 3 mm inclusively as «narrow» and «wide» from 4 or more. In 45 (41.7%) patients with a narrow duct POPF occured in 17 patients (37.8%), in 63 patients with a wide Wirsung duct (58.3%) POPF developed in 9 patients (14.3%) (p < 0.01). The volume of intraoperative blood loss less than 400 ml was regarded as physiological, this volume of blood loss was observed in 90 patients (83.3%), POPF occurred in 24 patients (26.7%), in 18 patients (17.7%) intraoperative blood loss exceeded 400 ml, POPF developed in 2 patients (11.1%) (p ˃ 0.05). All 100% of patients underwent pancreatojejunostomy at the reconstructive stage of the operation. 89 patients underwent duct-to-mucosa anastomosis, in the standard version without transanastomotic catheter, POPF occurred in 18 patients (20.0%), the rest included different options with transanastomotic catheter with or without invagination component , in this group (19 patients) PF developed in 8 people (44.4%). A statistically significant difference (p < 0.05) was obtained, however, due to the fact that a departure from the standard in the group of patients with combination of a narrow duct and soft pancreas, objectification of such a risk factor is impossible. Conclusion: In our study, the factors that significantly increase the frequency of POPF formation were the degree of pancreas density and the diameter of the pancreatic duct.