Giovanni Domenico Tebala, Amanda Shabana, Mahul Patel, Benjamin Samra, Alan Chetwynd, Mickaela Nixon, Siddhee Pradhan, Bara'a Elhag, Gabriel Mok, Alexandra Mighiu, Diandra Antunes, Zoe Slack, Roberto Cirocchi, Giles Bond-Smith
{"title":"Prognostic factors and predictive models in hot gallbladder surgery: A prospective observational study in a high-volume center.","authors":"Giovanni Domenico Tebala, Amanda Shabana, Mahul Patel, Benjamin Samra, Alan Chetwynd, Mickaela Nixon, Siddhee Pradhan, Bara'a Elhag, Gabriel Mok, Alexandra Mighiu, Diandra Antunes, Zoe Slack, Roberto Cirocchi, Giles Bond-Smith","doi":"10.14701/ahbps.23-112","DOIUrl":"10.14701/ahbps.23-112","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The standard treatment for acute cholecystitis, biliary pancreatitis and intractable biliary colics (\"hot gallbladder\") is emergency laparoscopic cholecystectomy (LC). This paper aims to identify the prognostic factors and create statistical models to predict the outcomes of emergency LC for \"hot gallbladder.\"</p><p><strong>Methods: </strong>A prospective observational cohort study was conducted on 466 patients having an emergency LC in 17 months. Primary endpoint was \"suboptimal treatment,\" defined as the use of escape strategies due to the impossibility to complete the LC. Secondary endpoints were postoperative morbidity and length of postoperative stay.</p><p><strong>Results: </strong>About 10% of patients had a \"suboptimal treatment\" predicted by age and low albumin. Postop morbidity was 17.2%, predicted by age, admission day, and male sex. Postoperative length of stay was correlated to age, low albumin, and delayed surgery.</p><p><strong>Conclusions: </strong>Several predictive prognostic factors were found to be related to poor emergency LC outcomes. These can be useful in the decision-making process and to inform patients of risks and benefits of an emergency vs. delayed LC for hot gallbladder.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"203-213"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139426196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kulbhushan Haldeniya, Krishna S R, Annagiri Raghavendra, Pawan Kumar Singh
{"title":"Laparoscopic subtotal cholecystectomy in difficult gallbladder: Our experience in a tertiary care center.","authors":"Kulbhushan Haldeniya, Krishna S R, Annagiri Raghavendra, Pawan Kumar Singh","doi":"10.14701/ahbps.23-168","DOIUrl":"10.14701/ahbps.23-168","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Open cholecystectomy is becoming obsolete and laparoscopic cholecystectomy has become the treatment of choice in gallstone diseases. Difficult gallbladders are encountered whenever there is a frozen calot's triangle, obliterated cystic plate, or both. Rather than converting to open procedure, there has been a growing preference for laparoscopic subtotal cholecystectomy (LSC) during difficult gallbladders. This study aimed to assess the advantages, indications, and viability of LSC in difficult gallbladders.</p><p><strong>Methods: </strong>The study included patients undergoing laparoscopic cholecystectomy in NIMS Hospital, Jaipur, from January 2021 to January 2023. Data of the patients who underwent LSC for difficult gallbladders included demographics, comorbidities, operative time, conversion to open cholecystectomy, length of hospital stay, and complications. LSC was classified into three types depending on the part of the gallbladder remnant.</p><p><strong>Results: </strong>A total of 728 patients underwent laparoscopic cholecystectomy. Among them, 41 patients (5.6%) were attempted for LSC. However, one patient was converted to an open procedure and the rest 40 underwent LSC. LSC was divided into 3 types, 4 patients underwent LSC type I, 34 patients underwent type II, and 2 patients type III. The average operating time and postoperative length of hospital stay were 86.2 minutes and 2.1 days, respectively. Two patients had surgical site infection. No patient had a bile leak and none required intensive care unit care.</p><p><strong>Conclusions: </strong>LSC is a safe and feasible option for use in difficult gallbladders.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"214-219"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139974782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comparison of short-term outcomes of open and laparoscopic assisted pancreaticoduodenectomy for periampullary carcinoma: A propensity score-matched analysis.","authors":"Utpal Anand, Rohith Kodali, Kunal Parasar, Basant Narayan Singh, Kislay Kant, Sitaram Yadav, Saad Anwar, Abhishek Arora","doi":"10.14701/ahbps.23-144","DOIUrl":"10.14701/ahbps.23-144","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Postoperative pancreatic fistula is the key worry in the ongoing debate about the safety and effectiveness of total laparoscopic pancreaticoduodenectomy (TLPD). Laparoscopic-assisted pancreaticoduodenectomy (LAPD), a hybrid approach combining laparoscopic resection and anastomosis with a small incision, is an alternative to TLPD. This study compares the short-term outcomes and oncological efficacy of LAPD vs. open pancreaticoduodenectomy (OPD).</p><p><strong>Methods: </strong>A retrospective analysis of data of all patients who underwent LAPD or OPD for periampullary carcinoma at a tertiary care center in Northeast India from July 2019 to August 2023 was done. A total of 30 LAPDs and 30 OPDs were compared after 1:1 propensity score matching. Demographic data, intraoperative and postoperative data (30 days), and pathological data were compared.</p><p><strong>Results: </strong>The study included a total of 93 patients, 30 underwent LAPD and 62 underwent OPD. After propensity score matching, the matched cohort included 30 patients in both groups. The LAPD presented several advantages over the OPD group, including a shorter incision length, reduced postoperative pain, earlier initiation of oral feeding, and shorter hospital stays. LAPD was not found to be inferior to OPD in terms of pancreatic fistula incidence (Grade B, 30.0% vs. 33.3%), achieving R0 resection (100% vs. 93.3%), and the number of lymph nodes harvested (12 vs. 14, <i>p</i> = 0.620). No significant differences in blood loss, short-term complications, pathological outcomes, readmissions, and early (30-day) mortality were observed between the two groups.</p><p><strong>Conclusions: </strong>LAPD has comparable safety, technical feasibility, and short-term oncological efficacy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"220-228"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrew Ang, Athena Michaelides, Claude Chelala, Dayem Ullah, Hemant M Kocher
{"title":"Prognostication for recurrence patterns after curative resection for pancreatic ductal adenocarcinoma.","authors":"Andrew Ang, Athena Michaelides, Claude Chelala, Dayem Ullah, Hemant M Kocher","doi":"10.14701/ahbps.23-149","DOIUrl":"10.14701/ahbps.23-149","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>This study aimed to investigate patterns and factors affecting recurrence after curative resection for pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>Consecutive patients who underwent curative resection for PDAC (2011-21) and consented to data and tissue collection (Barts Pancreas Tissue Bank) were followed up until May 2023. Clinico-pathological variables were analysed using Cox proportional hazards model.</p><p><strong>Results: </strong>Of 91 people (42 males [46%]; median age, 71 years [range, 43-86 years]) with a median follow-up of 51 months (95% confidence intervals [CIs], 40-61 months), the recurrence rate was 72.5% (n = 66; 12 loco-regional alone, 11 liver alone, 5 lung alone, 3 peritoneal alone, 29 simultaneous loco-regional and distant metastases, and 6 multi-focal distant metastases at first recurrence diagnosis). The median time to recurrence was 8.5 months (95% CI, 6.6-10.5 months). Median survival after recurrence was 5.8 months (95% CI, 4.2-7.3 months). Stratification by recurrence location revealed significant differences in time to recurrence between loco-regional only recurrence (median, 13.6 months; 95% CI, 11.7-15.5 months) and simultaneous loco-regional with distant recurrence (median, 7.5 months; 95% CI, 4.6-10.4 months; <i>p</i> = 0.02, pairwise log-rank test). Significant predictors for recurrence were systemic inflammation index (SII) ≥ 500 (hazard ratio [HR], 4.5; 95% CI, 1.4-14.3), lymph node ratio ≥ 0.33 (HR, 2.8; 95% CI, 1.4-5.8), and adjuvant chemotherapy (HR, 0.4; 95% CI, 0.2-0.7).</p><p><strong>Conclusions: </strong>Timing to loco-regional only recurrence was significantly longer than simultaneous loco-regional with distant recurrence. Significant predictors for recurrence were SII, lymph node ration, and adjuvant chemotherapy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"248-261"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tae-Seok Kim, Kwangho Yang, Gi Hong Choi, Hye Yeon Yang, Dong-Sik Kim, Hye-Sung Jo, Gyu-Seong Choi, Kwan Woo Kim, Young Chul Yoon, Jaryung Han, Doo Jin Kim, Shin Hwang, Koo Jeong Kang
{"title":"Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis.","authors":"Tae-Seok Kim, Kwangho Yang, Gi Hong Choi, Hye Yeon Yang, Dong-Sik Kim, Hye-Sung Jo, Gyu-Seong Choi, Kwan Woo Kim, Young Chul Yoon, Jaryung Han, Doo Jin Kim, Shin Hwang, Koo Jeong Kang","doi":"10.14701/ahbps.24-048","DOIUrl":"10.14701/ahbps.24-048","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is classified as the advanced stage (BCLC stage C) with extremely poor prognosis, and in current guidelines is recommended for systemic therapy. This study aimed to evaluate the surgical outcomes and long-term prognosis after hepatic resection (HR) for patients who have HCC combined with PVTT.</p><p><strong>Methods: </strong>We retrospectively analyzed 332 patients who underwent HR for HCC with PVTT at ten tertiary referral hospitals in South Korea.</p><p><strong>Results: </strong>The median overall and recurrence-free survival after HR were 32.4 and 8.6 months, while the 1-, 3-, and 5-year overall survival rates were 75%, 48%, and 39%, respectively. In multivariate analysis, tumor number, tumor size, AFP, PIVKA-II, neutrophil-to-lymphocyte ratio, and albumin-bilirubin (ALBI) grade were significant prognostic factors. The risk scoring was developed using these seven factors-tumor, inflammation and hepatic function (TIF), to predict patient prognosis. The prognosis of the patients was well stratified according to the scores (log-rank test, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>HR for patients who have HCC combined with PVTT provided favorable survival outcomes. The risk scoring was useful in predicting prognosis, and determining the appropriate treatment strategy for those patients who have HCC with PVTT.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"134-143"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyung Sun Kim, Mee Joo Kang, Jingu Kang, Kyubo Kim, Bohyun Kim, Seong-Hun Kim, Soo Jin Kim, Yong-Il Kim, Joo Young Kim, Jin Sil Kim, Haeryoung Kim, Hyo Jung Kim, Ji Hae Nahm, Won Suk Park, Eunkyu Park, Joo Kyung Park, Jin Myung Park, Byeong Jun Song, Yong Chan Shin, Keun Soo Ahn, Sang Myung Woo, Jeong Il Yu, Changhoon Yoo, Kyoungbun Lee, Dong Ho Lee, Myung Ah Lee, Seung Eun Lee, Ik Jae Lee, Huisong Lee, Jung Ho Im, Kee-Taek Jang, Hye Young Jang, Sun-Young Jun, Hong Jae Chon, Min Kyu Jung, Yong Eun Chung, Jae Uk Chong, Eunae Cho, Eui Kyu Chie, Sae Byeol Choi, Seo-Yeon Choi, Seong Ji Choi, Joon Young Choi, Hye-Jeong Choi, Seung-Mo Hong, Ji Hyung Hong, Tae Ho Hong, Shin Hye Hwang, In Gyu Hwang, Joon Seong Park
{"title":"Practice guidelines for managing extrahepatic biliary tract cancers.","authors":"Hyung Sun Kim, Mee Joo Kang, Jingu Kang, Kyubo Kim, Bohyun Kim, Seong-Hun Kim, Soo Jin Kim, Yong-Il Kim, Joo Young Kim, Jin Sil Kim, Haeryoung Kim, Hyo Jung Kim, Ji Hae Nahm, Won Suk Park, Eunkyu Park, Joo Kyung Park, Jin Myung Park, Byeong Jun Song, Yong Chan Shin, Keun Soo Ahn, Sang Myung Woo, Jeong Il Yu, Changhoon Yoo, Kyoungbun Lee, Dong Ho Lee, Myung Ah Lee, Seung Eun Lee, Ik Jae Lee, Huisong Lee, Jung Ho Im, Kee-Taek Jang, Hye Young Jang, Sun-Young Jun, Hong Jae Chon, Min Kyu Jung, Yong Eun Chung, Jae Uk Chong, Eunae Cho, Eui Kyu Chie, Sae Byeol Choi, Seo-Yeon Choi, Seong Ji Choi, Joon Young Choi, Hye-Jeong Choi, Seung-Mo Hong, Ji Hyung Hong, Tae Ho Hong, Shin Hye Hwang, In Gyu Hwang, Joon Seong Park","doi":"10.14701/ahbps.23-170","DOIUrl":"10.14701/ahbps.23-170","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Reported incidence of extrahepatic bile duct cancer is higher in Asians than in Western populations. Korea, in particular, is one of the countries with the highest incidence rates of extrahepatic bile duct cancer in the world. Although research and innovative therapeutic modalities for extrahepatic bile duct cancer are emerging, clinical guidelines are currently unavailable in Korea. The Korean Society of Hepato-Biliary-Pancreatic Surgery in collaboration with related societies (Korean Pancreatic and Biliary Surgery Society, Korean Society of Abdominal Radiology, Korean Society of Medical Oncology, Korean Society of Radiation Oncology, Korean Society of Pathologists, and Korean Society of Nuclear Medicine) decided to establish clinical guideline for extrahepatic bile duct cancer in June 2021.</p><p><strong>Methods: </strong>Contents of the guidelines were developed through subgroup meetings for each key question and a preliminary draft was finalized through a Clinical Guidelines Committee workshop.</p><p><strong>Results: </strong>In November 2021, the finalized draft was presented for public scrutiny during a formal hearing.</p><p><strong>Conclusions: </strong>The extrahepatic guideline committee believed that this guideline could be helpful in the treatment of patients.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"161-202"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evelyn Waugh, Juan Glinka, Daniel Breadner, Rachel Liu, Ephraim Tang, Laura Allen, Stephen Welch, Ken Leslie, Anton Skaro
{"title":"Survival benefit of neoadjuvant FOLFIRINOX for patients with borderline resectable pancreatic cancer.","authors":"Evelyn Waugh, Juan Glinka, Daniel Breadner, Rachel Liu, Ephraim Tang, Laura Allen, Stephen Welch, Ken Leslie, Anton Skaro","doi":"10.14701/ahbps.23-107","DOIUrl":"10.14701/ahbps.23-107","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>While patients with borderline resectable pancreatic cancer (BRPC) are a target population for neoadjuvant chemotherapy (NAC), formal guidelines for neoadjuvant therapy are lacking. We assessed the perioperative and oncological outcomes in patients with BRPC undergoing NAC with FOLFIRINOX for patients undergoing upfront surgery (US).</p><p><strong>Methods: </strong>The AHPBA criteria for borderline resectability and/or a CA19-9 level > 100 μ/mL defined borderline resectable tumors retrieved from a prospectively populated institutional registry from 2007 to 2020. The primary outcome was overall survival (OS) at 1 and 3 years. A Cox Proportional Hazard model based on intention to treat was used. A receiver-operator characteristics (ROC) curve was constructed to assess the discriminatory capability of the use of CA19-9 > 100 μ/mL to predict resectability and mortality.</p><p><strong>Results: </strong>Forty BRPC patients underwent NAC, while 46 underwent US. The median OS with NAC was 19.8 months (interquartile range [IQR], 10.3-44.24) vs. 10.6 months (IQR, 6.37-17.6) with US. At 1 year, 70% of the NAC group and 41.3% of the US group survived (<i>p</i> = 0.008). At 3 years, 42.5 % of the NAC group and 10.9% of the US group survived (<i>p</i> = 0.001). NAC significantly reduced the hazard of death (adjusted hazard ratio, 0.20; 95% confidence interval, 0.07-0.54; <i>p</i> = 0.001). CA19-9 > 100 μ/mL showed poor discrimination in predicting mortality, but was a moderate predictor of resectability.</p><p><strong>Conclusions: </strong>We found a survival benefit of NAC with FOLFIRINOX for BRPC. Greater pre-treatment of CA19-9 and multivessel involvement on initial imaging were associated with progression of the disease following NAC.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"229-237"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A case of laparoscopic excision of choledochal cyst, hepaticojejunostomy, and Roux-en-Y anastomosis using Artisential<sup>®</sup>.","authors":"Younghoon Shim, Chang Moo Kang","doi":"10.14701/ahbps.23-114","DOIUrl":"10.14701/ahbps.23-114","url":null,"abstract":"<p><p>Choledochal cyst is a condition involving an abnormal dilation of the bile ducts, which can lead to various symptoms and comorbidities, including cancer. The treatment of choice for choledochal cyst is surgical correction including choledochal cyst excision and Roux-en-y hepaticoenterostomy. Minimal invasive methods like laparoscopic methods or robotic methods are used for surgical correction of choledochal cysts; however, it is still controversial which method is superior. A Korean company, LIVESMED, developed Artisential<sup>®</sup>, a laparoscopic surgical instrument that can overcome the drawbacks of laparoscopic methods. This article presents a case of the first Artisential<sup>®</sup>-performed surgical excision of a choledochal cyst and hepaticojejunostomy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"266-269"},"PeriodicalIF":0.0,"publicationDate":"2024-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11128786/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139486548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Thanh Khiem Nguyen, Ham Hoi Nguyen, Tuan Hiep Luong, Kim Khue Dang, Van Duy Le, Duc Dung Tran, Van Minh Do, Hong Quang Pham, Hoan My Pham, Thi Lan Tran, Cuong Thinh Nguyen, Hong Son Trinh, Yosuke Inoue
{"title":"Pancreaticoduodenectomy with superior mesenteric artery first-approach combined total meso-pancreas excision for periampullary malignancies: A high-volume single-center experience with short-term outcomes.","authors":"Thanh Khiem Nguyen, Ham Hoi Nguyen, Tuan Hiep Luong, Kim Khue Dang, Van Duy Le, Duc Dung Tran, Van Minh Do, Hong Quang Pham, Hoan My Pham, Thi Lan Tran, Cuong Thinh Nguyen, Hong Son Trinh, Yosuke Inoue","doi":"10.14701/ahbps.23-068","DOIUrl":"10.14701/ahbps.23-068","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Pancreaticoduodenectomy (PD) is the only radical treatment for periampullary malignancies. Superior mesenteric artery (SMA) first approach combined with total meso-pancreas (MP) excision was conducted to improve the oncological results. There has not been any previous research of a technique that combines the SMA first approach and total MP excision with a detailed description of the MP macroscopical shape.</p><p><strong>Methods: </strong>We prospectively assessed 77 patients with periampullary malignancies between October 2020 and March 2022 (18 months). All patients had undergone PD with SMA first approach combined total MP excision. The perioperative indications, clinical data, intra-operative index, R0 resection rate of postoperative pathological specimens (especially mesopancreatic margin), postoperative complications, and follow-up results were evaluated.</p><p><strong>Results: </strong>The median operative time was 289.6 min (178-540 min), the median intraoperative blood loss was 209 mL (30-1,600 mL). Microscopically, there were 19 (24.7%) cases with metastatic MP, and five cases (6.5%) with R1-resection of the MP. The number of lymph nodes (LNs) harvested and metastatic LNs were 27.2 (maximum was 74) and 1.8 (maximum was 16), respectively. Some (46.8%) patients had pancreatic fistula, but mostly in grade A, with 7 patients (9.1%) who required re-operations. Some 18.2% of cases developed postoperative refractory diarrhea. The rate of in-hospital mortality was 1.3%.</p><p><strong>Conclusions: </strong>The PD with SMA first approach combined TMpE for periampullary malignancies was effective in achieving superior oncological statistics (rate of MP R0-resection and number of total resected LNs) with non-inferior short-term outcomes. It is necessary to evaluate survival outcomes with long-term follow-up.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"59-69"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Port-site metastasis after laparoscopic radical pancreatosplenectomy in left-sided pancreatic cancer.","authors":"Su Hyeong Park, Zhanay Zhassanov, Chang Moo Kang","doi":"10.14701/ahbps.23-092","DOIUrl":"10.14701/ahbps.23-092","url":null,"abstract":"<p><p>Despite debates regarding the safety of well-selected left-sided pancreatic cancer, minimally invasive distal pancreatosplenectomy is considered safer and more effective than open distal pancreatosplenectomy in well-selected patients. Previous studies have shown that minimally invasive surgery yields comparable oncologic outcomes to open surgery. While patients who undergo minimally invasive distal pancreatosplenectomy also experience recurrences and metastases after surgery, port-site metastasis is particularly rare. In this report, we report an extremely rare case of port-site metastasis following minimally invasive distal pancreatosplenectomy for left-sided pancreatic cancer.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"104-108"},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10896680/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139099307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}