Aim. Evaluation of surgical outcomes in elderly and senile patients with portal cholangiocarcinoma.Materials and methods. The immediate and long-term results of surgical treatment of 170 patients with portal cholangiocarcinoma performed in 2013–2023 were analyzed. A comparison of the outcomes in patients aged below 60, 60–74, and over 74 years old was carried out. Factors prognostically associated with a high risk of fatal outcome in elderly and senile patients were determined by multivariate logistic regression analysis.Results. The senile patient group was more likely to develop severe complications (p = 0.089) and had a higher 90-day mortality (p = 0.042). The combination of such factors as the Charlson comorbidity index, Comprehensive Risk Score (CRS), resection volume, and surgery duration showed high prognostic significance with respect to hospital mortality, with an area under the ROC curve (AUC) of 0.895 (p < 0.001). The overall and recurrence-free survival of patients did not differ among all age groups (p = 0.886).Conclusion. In the absence of appropriate patient selection based on risk factors, the surgical outcomes in senile patients deteriorate. When planning a surgical intervention in senile patients, attention should be paid to minimizing surgical trauma and surgery duration, especially in patients with a high comorbidity index.

Aim. To estimate the learning curve for laparoscopic liver resections performed by a surgeon experienced in robot-assisted liver resections using the CUSUM method. Materials and methods. The study involved a retrospective analysis of the results of laparoscopic liver resections for malignant and benign neoplasms performed from 2015 to December 2020 and robot-assisted liver resections from 2010 to 2020. The author evaluated the learning curve for laparoscopic liver resections of a surgeon who had mastered robot-assisted resections of high difficulty. Selecting the boundaries between training periods according to the obtained CUSUM graphs was determined by critical changes in the resection difficulty score (IWATE and IMM), duration of surgery, blood loss, and incidence of postoperative complications. Major perioperative events were compared between the laparoscopic and robot-assisted resection groups in each of the training periods. Results. 174 laparoscopic and 57 robot-assisted liver resections were performed. The duration of the first training period comprised 11 robot-assisted resections and 20 laparoscopic resections, the second period – 16 and 20, the third period – 30 and 134, accordingly. In the second period, the resection difficulty score increased significantly for both groups, while the amount of blood loss, the incidence of postoperative complications, and the duration of hospital treatment did not differ significantly. In the second training period, the duration of surgery was significantly longer in both groups. Conclusion. Studying the dynamics of surgical difficulty using the CUSUM method is considered to be a reliable, controlled way to estimate the learning curve for liver resection. Completing the learning curve for robot-assisted liver resections reduces the duration of the learning curve for laparoscopic resections compared to published data of other authors.

Aim. To develop the concept of prevention and treatment of severe complications after radical surgery for portal cholangiocarcinoma based on a comparative analysis of two periods of the surgical treatment program. Materials and methods. The study involved an analysis of multidisciplinary treatment of patients with portal cholangiocarcinoma for 8 years (2013–2020). The study consisted of two stages: program formation in 2013–2018 and evaluation of results in 2019–2020. Results. 140 patients with portal cholangiocarcinoma underwent radical or relatively radical surgery: 94 patients in the first period and 46 patients in the second period. 35 pairs of observations were formed by means of propensity score matching. In the second period, the incidence of Clavien-Dindo grade IV and V complications, CCI>40 index, duration of stay in the intensive care unit, and 90-day mortality significantly decreased. Proven reasons for the improvements included more thorough preparation of patients for the resection stage of treatment, elimination of clinical and laboratory manifestations of biliary drainage complications, careful invasive monitoring of fluid accumulations, and prevention of cholangitis. Conclusion. Maximum compensation of inflammatory and trophic disorders, elimination of jaundice, prevention and early elimination of complications as a result of their prognosis and monitoring at all stages of treatment reliably improve the immediate results of radical surgery for portal cholangiocarcinoma.

The Russian consensus on the treatment of intrahepatic cholangiocarcinoma was prepared by the group of experts consisting of surgeons, interventional radiologists, radiation therapists and oncologists. The purposes of this consensus are clarification and consolidation of opinions of multidisciplinary team on the following issues of management of patients with intrahepatic cholangiocarcinoma: indications for surgical treatment, features of therapeutic tactics for mechanical jaundice, technical aspects of liver resection, prevention of post-resection liver failure, indications for liver resection using transplantation technologies, laparoscopic and robot-assisted liver resection, perioperative systemic chemotherapy, local non-resection/non-radiotherapy methods of treatment, radiotherapy, follow-up and choice of treatment for recurrence.

Aim. To review the comparative studies into robot-assisted and open surgeries for hilar cholangiocarcinoma. Materials and methods. Search for the comparative studies into the results of robot-assisted and open surgeries in patients with hilar cholangiocarcinoma was performed using electronic databases Embase, MEDLINE, Web of Science and Google Scholar by keywords “robotic” AND “hilar cholangiocarcinoma” OR “perihilar cholangiocarcinoma” OR “Klatskin tumor” published by December 31, 2023. Results. The meta-analysis involves the results of 169 resections, including 53 robot-assisted and 116 open surgeries. Robot-assisted interventions revealed longer surgery duration (weighted mean difference (WMD) = 157.49, CI = 95 % [102.85; 212.12], р < 0.00001), less amount of intraoperative blood loss, close to statistically significant (WMD = −76.41, CI = 95 % [−159.90; 7.08], р = 0.07). Robot-assisted and open surgery groups appear comparable in terms of their perioperative parameters, including blood transfusion rate, number of R0 resections, number of lymph nodes removed, rate of postoperative complications, length of hospital stay, in-hospital mortality, as well as overall and event-free survival rates. Conclusion. Meta-analysis of short-term and long-term outcomes of robot-assisted and open surgeries for hilar cholangiocarcinoma of the liver and bile ducts proves the potential and possibility for using robotic technologies in selective patients.

Aim. To evaluate the immediate results of robot-assisted liver resections in locally advanced intrahepatic cholangiocarcinoma.Materials and methods. The research methodology involved the analysis of intraoperative and direct results of robotassisted liver resections from 2015 to June 2023.Results. Total of 89 patients with intrahepatic cholangiocarcinoma underwent surgery. Open liver resection was performed in 59 cases (66.3%), laparoscopic resection – in 22 cases (24.7%), robot-assisted resection – in 8 cases (8.9%). The share of massive liver resections accounted for 83%. The average duration of robot-assisted liver resection amounted to 545 (327–640) minutes, blood loss volume – 300 (100–750) ml, number of resected lymph nodes – 7 (5–11), resection margin width – 6 (5–14) mm. All patients underwent extensive resection with elements of vascular or biliary resection. Severe complications developed only in half of the patients. No deaths or liver failures were reported. The average duration of hospital stay after surgery amounted to 11 (6–15) days.Conclusion. Robot-assisted liver resections expand the indications for minimally invasive surgeries in intrahepatic cholangiocarcinoma due to patients with locally advanced forms. Satisfactory immediate results justify further accumulation and evaluation of the experience of such interventions.

Aim: to evaluate the short- and long-term outcomes of laparoscopic and open operations in the treatment of hepatic echinococcosis.Materials and methods. The results of laparoscopic and open echinococcectomies performed from 2013 to 2020 were retrospectively studied. Laparoscopic operations were considered the method of choice. Open operations were performed in cases with contraindications to the laparoscopic approach.Results. In total, 57 patients were operated: 47 laparoscopically (including robotic approach in 4 cases), 9 patients underwent open surgery. Radical procedures prevailed among laparoscopic cystectomies: 46 (98%). In the groups of laparoscopic/open cystectomies, partial pericystectomy was performed in 1/3 of patients, subtotal – in 24/4, total – in 13/0, and liver resection – in 9/2 patients, respectively. Laparoscopic procedures were performed mainly for types 1 and 3 of cysts, open procedures – for type 2 (WHO), recurrent and extrahepatic abdominal cysts were indication for open surgery. The frequency of severe complications did not differ between the groups. In the laparoscopic group, 1 (2%) patient died. After laparoscopic cystectomies, the mean (median) hospital stay (8 vs 10 days) and duration of abdominal drainage (10 vs 12 days) were significantly shorter. Relapse occurred only after conservative cystectomies, in one patient in each group.Conclusion. Laparoscopic radical surgery for liver hydatid cysts may be the method of choice if performed in a specialized HPB center. Patient selection criteria should be based on the center's experience in laparoscopic liver surgery.

The article presents an analysis of the results of the three most important international consensus conferences on the development, dissemination, assessment of the efficacy and safety of laparoscopic liver resection (2008, 2014 and 2017). An analysis of world experience has demonstrated the slow but steady diffusion of the new technology. It is proved that the immediate outcomes of laparoscopic liver resection are superior to those for open resections, and the long-term results do not differ in the treatment of the most common oncological and benign liver tumors in selected patients. Unlike laparoscopic surgery of other organs of the abdominal cavity, many issues regarding the technology, safety and reproducibility of the operation did not receive a final solution due to the slower data set and other objective obstacles associated primarily with the complexity of the surgical anatomy of the liver. In this regard, a clear achievement of the expert's work should be considered a clear definition of the strategy for mastering the technology of laparoscopic liver resection, as well as selection of patients to avoid serious errors and discrediting the method. All conferences remained in line with the initially emerging trends, adding more evidence-based research to confirm and refine the capabilities of the technology. There is still a shortage of prospective randomized trials and large national and international registries. Further analysis of experience in this direction will allow us to correct the previously obtained data and more clearly indicate the role and place of laparoscopic liver resection in the arsenal of methods of modern surgical hepatology.

Background. Minimally invasive radical surgery for perihilar cholangiocarcinoma is in its early stages. Aim. A comparative analysis of the initial experience of robot-assisted and open resections for perihilar cholangiocarcinoma. Material and methods. The single-center experience, accumulated over the period from 2014 to 2018, is analyzed. Robot-assisted procedures included major liver resection and caudate lobectomy with extrahepatic bile duct resection and lymphadenectomy. The need for vascular reconstruction was considered a contraindication to surgery. Results. Thirteen robot-assisted resections were performed. The perihilar cholangiocarcinoma was confirmed by pathologic examination in 10 patients. The immediate outcomes were compared with that in 88 open procedures. There were no significant differences in blood loss, the rate of severe morbidity, mortality, and hospital stay. The duration of the robot-assisted surgical resections was significantly longer. Conclusion. Analysis of initial experience justifies the robotic approach for radical resection in highly selected patients.

Aim: comparative analysis of peri-operative results of laparoscopic and open liver resections for hepatocellular carcinoma.Matherial and methods. A retrospective analysis included 73 patients with hepatocellular carcinoma who underwent liver resection from 2014 to 2019. In patients with liver cirrhosis contraindications were: 2 degree of varicose veins of eosophagus, severe ascites, liver cirrhosis class B and C (Child–Pugh)Results. Average operation time in comparing groups did not differ. Bloodloss (502 ml and 1380 ml), frequancy of complications by Clavien–Dindo (32.6% and 55.5%), duration of post-operative hospital stay (8 days and 13,6 days) were significantly less in the group of patients with laparoscopic liver resection (р < 0.05). In the early postoperative period, 2 (2.7%) patients died due to sepsis and posthepatectomy liver failure. There were no fatal outcomes in the group of laparoscopic liver resections.Conclusion. Laparoscopic liver resections for hepatocellular carcinoma has advantages in terms of prevention intraoperative bloodloss, and allow to reduce perioperative complications and post-operative hospital stay. This is important for rapid recovery of patients and for prompt ongoing of complex treatment.

Aim. To compare survival after open liver resections and laparoscopic liver resection based on the experience of two large Russian surgical centers using the propensity score matching. Material and methods. The primary point of the study was the assessment of long-term overall and disease-free survival after laparoscopic and open liver resection. The secondary point were immediate outcomes. Propensity score matching was used for balancing covariates and reducing the drawbacks of observational study. Results. The study included data from 185 patients after 93 laparoscopic liver resection and 92 open liver resection. The immediate outcomes of 176 patients (95%) were analyzed. Long-term results were evaluated in 157 patients (85%) with propensity score based analysis. Forty-three pairs were matched. The blood loss and the hospital stay were less in the group of laparoscopic liver resection before matching. After matching, the blood loss was equal in both groups. The length of hospital stay remained significantly shorter in laparoscopic liver resection group after matching. No differences in severe morbidity was observed between groups. No death was registered after open and laparoscopic liver resection. The overall 5-year survival rate in the laparoscopic and open liver resection groups did not differ before and after matching (56%/68% and 72%/76%, respectively). Disease-free 5- and 4-year survival did not differ either, but revealed the trend to be longer after laparoscopic liver resection before and after matching (52%/10% and 58%/28%, respectively). Conclusion. Laparoscopic liver resection for colorectal liver metastases reduced the hospital stay. The overall survival of patients did not depend on the type of approach. Disease-free survival discovered the trend to improve after laparoscopic liver resection.