HPB Blog, April 2015

The Spring issue of HPB presents a wide variety of different papers with laparoscopic liver surgery being a featured topic with three separate papers on this evolving area of HPB surgery. The first article from Nick O’Rourke’s group in Brisbane presents an analysis of 19 patients who underwent laparoscopic resection of high ‘dome’ lesions in the liver. This article contains some really useful hints and tips for port and patient placement and technique in what is a challenging position to deal with a liver tumour.

The second article from Lee and colleagues presents a 2:1 matched pair analysis of patients undergoing laparoscopic left lateral sectionectomy versus open resection for HCC. The laparoscopic resected patients had significantly lower blood loss, length of stay, severity of complications and lower readmission rates. Overall complications, and cancer outcomes were similar. This article was one of the editorial highlight articles.

The final article on laparoscopic liver resection was a health economic analysis of laparoscopic versus open left lateral sectionectomy from the group in Leeds, UK.   This study shows significantly lower costs for the laparoscopic approach compared with the open approach. The majority of the cost saving for laparoscopic surgery is shorter postoperative hospital stay and it is interesting that consumable equipment costs were only slightly higher for laparoscopic surgery.

Staying on the health economics theme, Kachare and colleagues from Greenville have conducted an analysis of the financial implications of complications from major pancreatic surgery on direct and indirect hospital costs. What is clear is that to avoid making a loss for the institution at Medicare rates, surgeons need to try and avoid patient complications if at all possible. The other side of this is that since elderly patients and those with comorbidity are at higher risk of complication, there is a potential risk that an element of financial discrimination could creep into clinical decision making.

http://onlinelibrary.wiley.com/doi/10.1111/hpb.12370/abstract

A study which is likely to attract considerable interest from HPB surgeons and in particular trainees, comes from Ali and colleagues from Cleveland Ohio.  This study looks at the training opportunities for surgeons declaring a subspecialty interest in HPB surgery. They found that while areas of the USA perform high volumes of HPB surgery the population as a whole is underserved and that training opportunities in a number of states are limited (for the number of subspecialty trainees). They call for better quality of training for HPB fellows given that training case opportunities do not appear to be increasing.

Janny and colleagues from Paris conducted a study which attempted to validate the Transfusion Risk Score proposed recently in the British Journal of Surgery by Pulitano and colleagues. They found that although each of the elements of the score was clinically relevant in the context of predicting transfusion the score only weakly correlated with the likelihood of perioperative transfusion in an external validation cohort. This study serves to underline the importance of collaboration and validation of predictive scores in different centres and health care systems.

The April issue of HPB contains far more than can be covered in this blog and there are interesting articles on management of hepatic leiomyosarcoma, cholangiocarcinoma and a clever technique for estimating adequacy of radiofrequency ablation burn zone using CT scanning. Other articles on cholecystostomy, delayed gastric emptying after pancreaticoduodenectomy and the importance of stroma in chemotherapy outcomes of pancreatic cancer make this essential reading for the HPB surgeon.

Click here for the table of contents

Stephen J Wigmore

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