Introduction: One of the important and characteristic features of perihilar cholangiocarcinoma is tumor invasion to the area of the portal vein bifurcation, which occurs in 30% to 45% of cases. The aim of our study was to asses results of surgical treatment of perihilar cholangiocarcinoma with (Group 1) and without (Group 2) portal vein invasion. Methods: From 2003 to January 2021 in the Department of Surgery and Liver Transplantation of the Ukrainian National Institute of Surgery and Transplantation, 170 patients with perihilar cholangiocarcinoma underwent major extended liver resections. Results: We compared 79 (46.5%) patients who received extended liver resection with portal vein resection with 91 (53.5%) patients who underwent liver resections without vascular reconstructions. In the preoperative period, 150 (88.5%) patients underwent decompression of the bile ducts, using percutaneous transhepatic cholangiostomy (PTBD) or retrograde endobiliary stenting. For patients with small remnant liver volume less than 40 %, in 42 cases we did preoperative PVE of a resected part of the liver. In 9 cases we made simultaneous PVE and PTBD. When choosing the volume of surgical intervention, we proceeded from the tumor type of Bismuth-Corlette classification, invasion into the portal vessels and the depth of the liver lesion. The portal vein reconstruction was in all cases performed in an "end-to-end". In all cases we made extended lymphadenectomy. Histologically, the tumor in 7 (11.5%) cases was well differentiated, in 47 (77%) cases-moderate differentiated, in 7 (11.5%) cases-poor differentiated. Conclusions: Aggressive surgical treatment for perihilar cholangiocarcinoma with portal vein resection can be performed.

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Introduction: Portal vein embolization (PVE) provokes tumor progression. LC decreases FLR regeneration capacity doubling the risk for patient dropout. Our aim was to develop method of FLR augmentation that convert aggressive tumor into safe vaccine and prolonged waiting period for FLR regeneration into effective In situ immunization period. Methods: 3 initially unresectable patients due to small FLR with advanced hepatocellular carcinoma (HCC) and LC were treated. Selective transarterial chemoembolization with short term biodegradable starch microspheres (DSM-TACE), into tumor bearing liver to be resected, was followed by simultaneous PVE of latter. Upon completion of PVE selective intratumoral immunotherapy (HIT-IT) with antiPD-L1 (atezolizumab 1,200 mg) into restored after DSM-TACE tumor arterial feeders (for selective connection with PD-L1 ligands located on tumor cells but not on normal human tissues) was done. DSM-TACE and HIT-IT was repeated one more time in all patients after postzenith decrease of T-cytotoxic cells. Results: Predominantly T and NK cells response was observed. All patients had successfully underwent major liver resection upon sufficient FLR regeneration. In all 3 cases we had achieved effective local tumor control via total or subtotal HCC necrosis, even more, in 1 (33%) case planned amount of liver resection was decreased due to achieved tumor downsizing. There were no severe morbidity or Immune-related adverse events (irAEs). Conclusions: Herein we had proposed new aggressive but safe method of FLR augmentation for patients with HCC and LC that could potentially preclude drop out of patients during anticipated prolonged waiting period of FLR augmentation and possible improves long-term outcomes by means of tumor downsizing and HCC immunoscore conversion.

Background: Borderline pancreatic adenocarcinoma (BPAC) may be technically resectable with high risks of R1 resection and postoperative recurrence. Neoadjuvant chemotherapy (NAC) is used without clear consensus. We present the preliminary Results of multidisciplinary management of BPAC patients Methods: We adopted the definition of the National Comprehensive Cancer Network (NCCN) for BPAC. All patients received neoadjuvant chemotherapy with at minimum 4 cures. The goal of this study was to investigate the morbidity and survival after surgical resection depending on the quality of oncological resection. Results: From September 2012 to December 2018,120 patients underwent pancreaticoduodenectomy (PD) for adenocarcinoma of the head of the pancreas. Among them, 34 (28%) had BPAC. Vascular resection was performed in 32% of patient. R0 resection was achieved in 56% of cases and R1 in 44%. According to surgical margin, R1 resections were divided into R1 0mm (54%) and R1 low ]0,1 mm[ (46%) Ninety-day mortality was nil. A pancreatic fistula occurred in 6% of patients. In terms of survival, overall (p=0.71) and recurrence-free (P=0.32) survival were similar to those in patients with resectable tumors. Same findings were noted between R0 et R1 low (p=0.72). Survival was statistically lower in the group R1 0mm when compared to survival of R0 group (P=0.05). Conclusions: Using a multidisciplinary approach to manage BPAC, good outcome could be achieved. Oncological quality of resection with at least R1 low resection is of paramount importance to ensure optimal survival.