HPB Blog, October 2014

October 2014

Absent South Beach and the blue waters and sunshine of Miami Beach, Florida, HPB readers can revisit the February 2014 meeting of the America’s HepatoPancreatoBiliary Association (AHPBA) in the October issue of our journal. In its largest meeting ever, the AHPBA welcomed members and delegates from all reaches of the Americas and from around the globe. HPB remains indebted to the AHPBA for its efforts to channel its highest quality manuscripts to us each year from the annual meeting.

We are welcomed to the issue by Dr. Will Chapman, President of the AHPBA and an acclaimed HPB and liver transplant surgeon from Washington University School of Medicine in St. Louis, Missouri. As I write this, the St Louis Cardinals are in hot pursuit of yet another baseball World Series Championship. For certain, Will is distracted these days! As you read his summary vignettes of our issue’s contents, you’ll learn key HPB updates instantly, but better, feel his pride of the accomplishments of the society he has so ably led.

Saxon Connor frames the issue of standardized clinical factors for HPB surgical patients. Indeed, any Editorial that begins with “Diametric conclusions by individual studies…” should catch attention. Sax unveils deeper considerations of the fistula risk score (FRS), and the predictive quality and function of future liver remnant (FLR) after resection. As to the FRS, Chuck Vollmer and I sought to provide our community an easy, non-headache method to use peri-operative variables to predict a bad outcome. It was offered for surgeons to use, identify, and include in the op note, but more importantly, to reveal whether the seas ahead are nasty or calm for their patients. We hope it will continue to be challenged and validated, but more importantly, to be used worldwide going forward.

Maria Russell’s team from Emory University in Atlanta sought to identify a valid peri-operative predictor of postoperative hepatic insufficiency after liver resection. Over 600 patients were studied. If a patient’s total bilirubin was over 3mg/dl on post-op day 3, watch out. Those patients had increased complications, major and minor, and higher 90-day mortality. Again… use, identify, react and protect.

Max Schmidt’s team from Indiana University scrutinizes the newly revised 2012 International Consensus Guidelines for IPMN in terms of preoperative prediction of malignancy and invasiveness. They identify compelling issues and weaknesses with the guidelines, all in the objective of maintaining a valid balance between under- and over-treatment of IPMN patients. Again…use, identify, react and protect.

Chuck Vollmer’s multi-institution team now effectively pulls the curtain down on prophylactic octreotide upon pancreatic resection to prevent post-op pancreatic fistula (POPF). The study evaluated over 1000 Whipple patients, a larger study than the prior RCTs. More importantly, the study is designed upon the spectrum of deliberate risk adjustment. POPF rates were higher in patients treated with octreodide. Sure it works sometimes, but only to mitigate biochemical, largely clinically-irrelevant fistulae. Take those away from the risk adjusted mix, and it is detrimental. As Sax Connor indicates, the data are “…hard to refute.”. So now…don’t use, and protect.

We hope you enjoy this BLOG. It will become lame pretty quickly if you don’t interact and drive its value and impact. Through editorials, manuscript reviews and issue highlights, you do hear a lot from us as Editors. We will be expanding our BLOG across our full Editorial Board so you can enjoy and benefit from the viewpoints of the world’s leaders in HPB Surgery. And, of course, use the interactive IHPBA website to grow your knowledge and impact in HPB.

It’s simple… Participate, Contribute and Enrich our Global HPB Community and those we serve. Get on Board!

To view the table of contents of this issue, click here.

Mark P. Callery, MD, FACS

Editor, HPB

Professor of Surgery

Harvard Medical School

Boston, Massachusetts,

USA

 

 

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