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Need for pancreatoduodenectomy or total pancreatectomy for retroperitoneal sarcoma is rare. In most cases, these procedures are determined by locally advanced neoplasm. The author report successful multivisceral resection in a patient with retroperitoneal sarcoma complicated by internal fistulae with duodenum and colon.

Mucinous cystadenoma is a cystic tumor of the pancreas absolutely requiring surgical intervention. The authors report successful surgical treatment of a patient with mucinous pancreatic cystadenoma complicated by severe intestinal bleeding.

Objective: To evaluate the early outcomes of radical surgical treatment of patients with resectable periampullary tumors and previous acute pancreatitis (AP)., Material and Methods: A retrospective analysis included 9 patients. AP was diagnosed in all patients at different times of preoperative period (post-manipulative AP in 7 cases, alcoholic AP in 2 cases). Pancreaticoduodenectomy was performed in 5 patients, total pancreatectomy (TP) - in 4 patients., Results: Severe postoperative complications occurred in 3 patients after pancreaticoduodenectomy. There were no complications after TP. All complications after pancreaticoduodenectomy were associated with a pancreatic stump that required urgent surgical interventions. Three patients died from surgical complications. All postoperative deaths were observed after pancreaticoduodenectomy., Conclusion: TP may be a safer surgical option compared to pancreaticoduodenectomy in patients with resectable periampiullary tumors and preoperative AP.

Specific complications is an «Achilles heel» of pancreaticoduodenectomy. Postoperative pancreatic fistula (POPF) is the most common specific complication. POPF prediction is an actual problem in pancreatic surgery. Analysis of statistically significant scoring systems to predict POPF is a modern trend in perioperative planning. Several prognostic scales (FRS, a-FRS, ua-FRS, Modified Fistula Risk Score) are recommended for clinical practice.

Aim: To analyze the results of radical surgery for upper GI cancer in patients ≥80 years old., Material and Methods: For the period November 2010 - June 2015 there were 14 radical operations in elderly (≥80 years) patients with gastric, liver and pancreatic tumors. There were 4 Whipple procedures, 4 total and 2 distal gastrectomies, 1 total pancreatectomy as well as a central liver resection, one laparoscopic 5 segment resection and one 2, 3, 7 segment resection. We analyzed blood loss, duration of surgery, 90-day mortality, morbidity (Dindo-Clavien scoring), length of hospital-stay., Results: Blood loss ranged from 0 to 1500 ml, mean duration of surgery - from 150 to 560 min. There was one case of in-hospital mortality: one patient after a Whipple procedure died in 17 days after surgery due to massive arrosive bleeding. Complications developed in 8 patients, 3 of them required reoperation. Mean hospital-stay was 15±6 (8-29) days., Conclusion: Advanced upper GI surgery for cancer is feasible in octagenarians and does not lead to inappropriate mortality and morbidity. Comprehensive preoperative examination alongside with enhanced recovery protocol are prerequisites for this type of surgery.

Aim: To assess safety and clinical-economic effectiveness of complex postoperative rehabilitation after pancreatoduodenectomy., Material and Methods: 73 patients were included in the study. Main group consisted of 39 patients who underwent accelerated postoperative rehabilitation that was developed in our clinic. In the control group of 34 patients this protocol was not applied. The main components of rehabilitation were multicomponent analgesia, early enteral nutrition, physical rehabilitation by using of exercise therapy and physiotherapy., Results: There were no significant differences in the incidence of postoperative complications and mortality (58.8% and 74.3%; p=0.213, 5.8% and 7.7%; p=0.678, respectively). Median of postoperative hospital-stay in the study group was 13 days (9; 16), in the control group - 15 days (9; 24). An estimated economic effect in the study group was 558 764, 84 rubles., Conclusion: Accelerated postoperative rehabilitation after pancreatoduodenectomy is safe and does not lead to increased number of postoperative complications and mortality. Developed protocol has clinical advantages and is cost-effective.

The aim was to estimate single center results of ALPPS. It was performed 5 ALPPS-procedures in our center during the period from February 2013 to March 2014. There were 1 female and 4 males in the age of 58-64 years. The indications for surgery were colorectal cancer metastases in 4 cases, bladder cancer metastases in 1 observation. The operations included 3 right-sided hemihepatectomies, 2 extended right-sided hemihepatectomies. In 3 cases operations were accompanied by additional atypical resection of residuary liver lobe. In 2 observations unsuccessful embolization of the portal vein was done. The waiting time between procedures consisted 18 days in the first case and 6 days in other cases. Final hepatectomy was performed in all observations. Hypertrophy of left liver lobe was more than 50% in all cases. Postoperative complications happened in 3 out of 5 cases. One patient died because of progressive thrombosis of inferior vena cava and developed multiorgan failure. There were 1 complication of level 2 and 1 complication of level 4a according to Dindo-Clavien classification. One patient had biliary fistula after final hepatectomy. It wasn't observed cases of severe liver failure. ALPPS is appropriate method for fast residuary liver lobe hypertrophy. It allows to perform R0-resection of liver but ALPPS has high postoperative complication rate.