Veronika Rozhkova

Introduction: In 2017 the laparoscopic left lateral sectionectomy and minor resections of the anterior liver segments were considered the standard of practice worldwide. However, in 2023 only 5% of liver resections were conducted laparoscopically within the Ukrainian specialized centers. Aim: To investigate whether the laparoscopic minor liver resections (LLR) have better financial, surgical and long-term oncological outcomes compared to open liver resections (OLR) in the two state specialized hospitals in Ukraine. Methods. Between January 2022 and June 2025, 205 patients with colorectal liver metastases (CLM) received either minor OLR or LLR. Primary end-points were the 30-day morbidity, surgical outcomes. Secondary endpoints were hospital costs and the oncological outcomes. Results: There was a difference in postoperative morbidity between the groups in favor of the LLR – 3.8% (n = 4) vs 11.7% (n = 12) in OLR (p = 0.04). 1.9% (n = 2) in the OLR group had major complications. No mortality was registered in either group. The final sum of costs for treatment of 103 patients in LLR vs 102 patients in OLR was 3.8M UAH vs 3.5M UAH, respectively (p = 0.82). The 2-year recurrence-free survival (RFS) was 44% vs 54%, and 19.6 months vs 24.0 months respectively for OLR and LLR groups (p = 0.62). Conclusions: The laparoscopic minor liver resections in patients with colorectal cancer liver metastases in state specialized hospitals reduced the recovery period and the postoperative morbidity level with similar oncological outcomes and costs.

Background. Extended epidural analgesia is widely used for postoperative pain control in oncological surgery. However, prolonged catheterization carries a risk of microbial colonization and infectious complications. In cancer patients, these risks are exacerbated by immunosuppression and impaired skin barrier function, underscoring the need to study the microbial spectrum and clinical implications of catheter colonization. Objective: to determine the frequency of bacterial colonization of epidural catheters, the spectrum of isolated microorganisms, and the clinical significance of these findings in patients undergoing oncological surgery. Materials and methods. A prospective study was conducted involving 51 patients who underwent prolonged epidural analgesia after oncological surgery. Demographic characteristics, somatic status, catheterization duration, incidence of infectious complications, and microbial culture results from catheter tips were analyzed. Statistical methods included descriptive analysis, Pearson’s test, Mann-Whitney U test, logistic regression, and Spearman correlation. Results. Positive cultures were found in 41.18 % of patients, with Staphylococcus epidermidis being the most common isolate. Clinical signs of infection were absent in 98 % of cases. No clinical-demographic variable showed a statistically significant association with colonization (p > 0.05), although body mass index had the strongest (nonsignificant) inverse correlation ( = –0.223). Colonization rates increased after more than 72 hours of catheterization. Conclusions. Epidural catheter colonization is common among cancer patients but rarely leads to clinically significant infections. Adherence to aseptic techniques and regular monitoring allow for the safe use of prolonged analgesia. Further research is needed to determine the optimal duration of catheterization and effective prevention strategies.

Background: Biliary drainage is frequently used in patients with perihilar obstruction. This study was designed to compare the microbiological characteristics of patients whose biliary trees were either exposed or not exposed to duodenal fluid, depending on the drainage method used.Methods: The charts of 71 patients with perihilar obstruction (any etiology causing an obstruction parallel to that of a proximal cholangiocarcinoma according to the Bismuth–Corlette classification) were evaluated retrospectively. The contacted group comprised 20 patients who underwent either endoscopic stenting or percutaneous transhepatic biliary drainage (PTBD) with duodenal extension, while the non-contacted group consisted of 51 patients with either external PTBD or surgery upfront.Results: Positive bile culture results were identified in 19/20 (95%) vs. 17/51 (33%) patients (p = 0.00001) and multimicrobial growth in 13/19 (68%) vs. 4/17 (24%) (p = 0.007) patients in the contacted group and non-contacted group, respectively. Colonization of bile with multidrug-resistant (MDR) and extensively drug-resistant (XDR) bacteria was worse in the contacted group: 13/19 (68%) vs. 5/17 (29%) (p = 0.02). Significant differences were also found in the frequencies of carbapenem-resistant Enterobacterales (CRE) colonization: in the contacted group, positive CRE culture (p = 0.033) and PCR (p = 0.01) were more frequent.Conclusions: The mode of the biliary drainage—duodenal vs. directly external—significantly modifies the microbiological characteristics of the patients with perihilar obstruction. Catheterization methods that entail continuous exposure of the biliary tree to duodenal fluid are associated with higher frequencies of bactibilia, presence of MDR and XDR bacteria in the bile, and intestinal colonization with CRE.

Pancreatic neoplasms are rare in children, resulting in limited data on pancreatectomy within this population. Our case series aims to contribute to the understanding of the indications, long- and short-term outcomes of surgical treatment for both benign and malignant pancreatic neoplasms in children. This is a retrospective review of pediatric patients (≤ 18 years old) who underwent resection for pancreatic neoplasms in a single tertiary referral center from July 2003 to November 2023. Overall, 31 patients with a median age of 13 years (range 1–15) were included in the study. Solid pseudopapillary neoplasm was diagnosed in 15 (48%) patients, neuroendocrine tumor– 7 (23%), serous cystadenoma– 2 (6%), pancreatic ductal adenocarcinoma– 2 (6%), pancreatoblastoma– 2 (6%), and lymphoma– 1 (3%). There were two rare cases of mature cystic teratoma and pancreatic paraganglioma. 20 (65%) distal pancreatectomies, 7 (23%) pancreaticoduodenectomies, and 4 (13%) tumor enucleations were performed. The laparoscopic approach was applied in 9 (29%) cases in the last seven years. There were 4 (13%) complications Clavien-Dindo ≥ 3, and no cases of perioperative mortality. The median follow-up was 114 months (range 10–131 months). 87% (27/31) of patients were alive without tumor recurrence. Surgical treatment remains the best chance for cure in patients with pancreatic neoplasms. These complex surgeries can be safely performed in the pediatric population with good long-term results. Advances in minimally invasive technique allow transition to less traumatic surgery in these patients.

Introduction and importance: In elderly patients with atherosclerotic disease the occlusion of splanchnic arteries is a frequently observed variation, which doesn't normally affect patient's condition. There are sporadic reports on pancreatoduodenectomy in these cases. Case presentation: A 72-year-old female was admitted to our department with cancer of the ampulla of Vater. Pre-operative CT-angiography revealed total atherosclerotic occlusion of the main trunk of the superior mesenteric artery (SMA). Collateral circulation was conducted through gastroduodenal and dorsal pancreatic artery. Pancreatoduodenectomy was performed with an intraoperative clamping test, which showed no signs of bowel ischemia. The patient was discharged on post-operative day 14 without any complications, and long-term follow-up revealed adjustment of collateral circulation through the inferior mesenteric artery and Riolan's arcade. Clinical discussion: Most cases of mesenteric artery stenosis occur in patients with underlying cardiac condition. As the occlusion develops chronically, it doesn't cause any symptoms due to collateral circulation, and no preoperative intervention is usually needed. However, there are rare cases reported in the literature, when preoperative endovascular stenting and SMA dilation were performed before pancreatoduodenectomy. In this report we decided to proceed with surgery upfront and perform an intraoperative clamping test. Conclusion: In this report we present a rare case of successful pancreatoduodenectomy in a patient with total atherosclerosis of the superior mesenteric artery. The intraoperative clamping test allowed us to assess both the sufficiency of collateral circulation and the feasibility of the surgery. Highlights:

Introduction and importance: Colorectal cancer ranks as one of the most common cancer globally. About half of the patients experience a disease recurrence in the form of сolorectal cancer liver metastasis (CRLM) within the first 5 years of the course of the disease. However, there are rare cases of delayed onset of liver metastasis, that occur after cessation of standard follow-up. Case presentation: A 38-year-old woman was referred to our institute with a metastatic liver mass adjacent to the liver hilum. The patient had sigmoid colectomy 10 years ago. After 6 cycles of chemotherapy, she underwent a central liver resection: Sg4, Sg5, Sg8v + middle hepatic vein with surgical skeletonization of 1st and 2nd order hepatic pedicles. The patient was discharged on 5th post-operative day. After 18th month of follow-up, the patient was alive without any signs of recurrence. Clinical discussion: The recommended follow-up of colorectal cancer patients is 5 years. However, there are rare instances of late metachronous liver recurrences, that suggest the necessity of more continuous surveillance. For patients with CRLM surgical resection is considered the most radical treatment of choice. The anatomy of Laennec's capsule allows the precise isolation of hepatic pedicles and can facilitate anatomical hepatectomy. Conclusion: We present a rare case report of borderline-resectable CRLM successfully treated with central liver resection with application of Laennec's approach a decade after the resection of a primary colorectal tumor. Highlights: