No abstract

Among the cholangiocarcinomas, the most common type is perihilar (phCC), accounting for approximately 60% of cases, after which are the distal and then intrahepatic forms. There is no staging system that allows for a comparison of all series and extraction of conclusions that increase the long-term survival rate of this dismal disease. The extension of the resection, which theoretically depends on the type of phCC, is not a closed subject. As surgery is the only known way to achieve a cure, many aggressive approaches have been adopted. Despite extended liver resections and even vascular resections, margins are positive in around one third of patients. In the past two decades, with advances in diagnostic and surgical techniques, surgical outcomes and survival rates have gradually improved, although variability is the rule, with morbidity and mortality rates ranging from 14% to 76% and from 0% to 19%, respectively. Extended hepatectomies and portal vein resection, or even right hepatic artery reconstruction for the left side tumors are frequently needed. Salvage procedures when arterial reconstruction is not feasible, as well as hepatopancreatoduodenectomy, are still under evaluation too. In this article, we discuss the aggressive surgical approach to phCC focused on vascular resection. Disparate results on the surgical treatment of phCC made it impossible to reach clear-cut conclusions.

Background: Leiomyosarcoma (LMS) of the vena cava inferior (VCI) is an extremely rare disease. The only curative treatment is achieved by R0 resection of the tumor. Methods: Here we present a case of a 10x8x8cm LMS of the VCI that was successfully R0 resected with extended right hepatectomy and enbloc VCI resection. Preoperative right portal vein embolization was performed to enlarge the future liver remnant. Complete VCI resection was performed transdiaphragmatically with clamping of the right atrium. The reconstruction was made with reimplantation of the left hepatic vein, two renal veins and right iliac vein on a 20mm goretex graft. Biliary reconstruction was made with Roux-Y cholangiojejunostomy with individual anastomosis of the Segment 2 and 3 bile ducts. Results: Postoperative course was eventless and the patient is tumor free 6 months postoperatively. Conclusion: R0 resection of VCI LMS can be achieved in tertiary HPB centers with capacity of multidisciplinary approach.

Chronic pancreatitis (CP) is a progressive inlammatory process, of the pancreatic gland and leads to damage and decrease in glandular tissue. Clinically, the pain is the most outstanding and incapacitating sign (95% of patients), as well as exocrine pancreatic insuiciency. The two main objectives in CP treatment are pain relief and complication management. Pain is the main surgical treatment indication. Patients with pancreatic duct dilation require surgical drainage, which provides an important pain relief (70-80%). Decompression (drainage), resection and neuroablation are the most commonly used surgical treatment options of CP. Derivative surgical procedures as Puestow-Gillesby or its modiication, Partington-Rochelle, are the best options if the Wirsung duct is dilated, and Izbiki procedure if it is not. Resection is the choice when there is an important afectation of the head of pancreas with repercussion in bile duct or duodenum, as well as those patients with suspicion of carcinoma or in those ones who cannot be ruled a malignant tumour. The resection surgical procedures are Whipple, Traverso-Longmire, Frey (resective-derivative) and Beger (resective-derivative). To conclude, surgeon must know not only every surgical procedure indications but also be familiarised with all of them. The surgical procedure must be individualised to the patient and the disease stage.

Background: Laparoscopic liver resection of tumors located in the posterosuperior segments is considered to be technically challenging.This study aimed to compare the perioperative outcomes for laparoscopic versus open resection of colorectal liver metastases (CRLM) located in the posterosuperior segments. Methods: This is a sub-study of the Oslo-CoMet trial. In this trial, 280 patients were randomly assigned to open or laparoscopic parenchyma sparing liver resections of CLRM. Inclusion was from February 2012 to February 2016. Patients with CRLM in posterosuperior segments were identified, and perioperative and short-term oncological outcomes were collected from the prospective trial database. The Accordion system and the Comprehensive Complication Index were used for grading of postoperative complication. Results: 62 patients underwent laparoscopic and 78 patients open liver resections. Postoperative complications developed in 22 cases (28.2%) in open group and 16 cases (25.4%) in laparoscopic group (p=0.71). The median postoperative hospital stay was 2 days in the laparoscopic and 4 days in the open group (p<0.001). Further perioperative outcomes will be presented at the congress. Conclusion: We found similar postoperative complications rate and decreased hospital stay, following laparoscopic resection of posterosuperior segments in patients with CRLM.