HPB Blog: September 2015

The September issue of HPB celebrates the best of HPB Surgery from the Americas and specifically papers presented at the AHPBA meeting in Florida in March 2015. There is an excellent overview of the highlights of the issue from Elijah Dixon, President of the AHPBA but to give you a flavour there are articles on almost every dimension of HPB Surgery.

There are some excellent overviews on equity of access to care for hepatocellular carcinoma (Hoehn et al), combined liver and pancreas resection (Tran et al), management of chronic pancreatitis in the USA  (Bliss et al) and bile duct reconstruction (Eskander et al). These ‘State of the Nation’ articles give useful insight into the delivery of healthcare in the United States and the common practices and outcomes.

At the more technical end of the spectrum a paper from Harris et al, highlights increased morbidity and mortality from colectomy at the time of pancreaticoduodenectomy . Another paper from Dua and colleagues looks at outcomes from different technical approaches to reconstruct the portal vein after resection as part of pancreaticoduodenectomy and conclude that primary end to end anastomoses and transvers venorrhaphy give superior outcomes compared with other techniques.  A further paper from Beane and colleagues looks at the morbidity of modified Appleby procedure involving distal pancreatectomy and coeliac axis resection and shows a ten fold increase in mortality compared with distal pancreatectomy not requiring coeliac axis resection. Tsang and colleagues matched control analysis looking at the question of whether pedicle clamping during liver resection influences outcomes for patients with colorectal liver metastases. Reassuringly, they found that it has no effect on overall or disease free survival which is good since pedicle clamping is such a useful pillar improving safety of modern liver surgery.

Two interesting papers address issues with training in HPB surgery in the USA. The first from Warner and colleagues looks at the quality of training experience in different programs as reported by trainees. They identified specific deficiencies in training in minimally invasive surgery and also in the use of ultrasound and this is useful information to hopefully improve quality of training. The second paper from Bressan and colleagues looks more at the issue of concordance of opinion between HPB trainees and their program directors. Program directors expressed concerns about excessive numbers of HPB trainees and the quality of training but interestingly there was good concordance between their opinion of adequacy of case volume and that of trainees and similarly on preparedness of trainees to undertake key procedures independently and the opinion of their program directors. Exposure to training in surgery for acute pancreatitis was highlighted as an area of potential deficiency.

These and other articles, which I do not have space to comment on, make for an issue of compelling reading in the September edition of HPB.

Click here for the Table of Contents

Stephen J Wigmore

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