The aim — to study the effectiveness of preoperative portal vein embolization (PVE) in patients with cholangiocarcinoma, preparing for radical expanded liver resection (ELR).Materials and methods. PVE was performed in 148 patients with cholangiocarcinoma as fierts step for ELR from 2006 to 2015. Indications for PVE were a future liver remnant (FLR) less than 30 % of total liver volume and a bilirubin level less than 300 mg/l. The change in liver volumes was evaluated by comparsion of CT scans before PVE and before ELR, liver function was assessed with standard laboratory tests.Results and discussion. As a result, PVE managed to achieve a statistically significant increase of FLR by 45.5 %, which made it possible to exclude all patients from high­risk group and to perform ELR in 141 (95.6 %) patients. The dynamics of laboratory tests indicates the processes of cytolysis and a decrease of synthetic liver function that occur after PVE with complete restoration for 3 weeks.Conclusions. PVE allows to increase FLR in patients with cholangiocarcinomas, in the absence of complications, which gives us the right to recommend the inclusion of this technique in the protocol for the preparation of patients with cholangiocarcinomatoexpanded liver resection.

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.

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.

Introduction: Portal Vein Embolization (PVE) is gold standard strategy to increase Future Liver Remnant (FLR) at level of Kinetic Growth Rate (KGR) about 2.3 cc/day and prevent posthepatectomy liver failure (PHLF) in patients to underwent major liver resections. Up to 30% of patients with liver malignances still couldn't underwent surgery after PVE due to tumor progression and/or insufficient FLR regeneration during waiting period. Currently there are no methods that resolve both mentioned issues. Method: Six initially unresectable, due to small FLR, patients with colorectal liver metastases (CRLM), in close proximity to FLR critical structures (portal and/or hepatocaval confluence), having more than three criteria of Fong Clinical Risk Score for CRLM were approved by Ethical Comitee for Simultaneous PVE and Transarterial Chemoembolization with Degradable Starch Microspheres (DSM-TACE). For those patients, SIMULTA-NEOUSLY with standard PVE, was performed

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