HPB Blog: October 2015

In its October issue now available on line, HPB offers its readership an exciting blend of reviews and practical original articles sure to please. During review and now better while reading the published content, I have been struck by the depth and quality of the studies as well as the practical and today knowledge they provide.

The issue opens with three terrific Review articles, two from Europe and one from New Zealand. Menahem et al from Caen Cedex, France sound yet another contemporary trumpet in support of prompt cholecystectomy for acute cholecystitis. Their analysis of 9 randomized controlled trials indicates that total hospital stay nearly doubles when laparoscopic cholecystectomy is delayed. One can assume costs do too. This adds to a rising wave worldwide suggesting that prompt cholecystectomy is a safe, sensible and resource-effective approach to acute cholecystitis. Hughes et al from Edinburgh, UK ask whether low central venous pressures (CVP) during liver resection provide more value than just reductions in operative blood loss. Apparently not. By analyzing 8 trials, they found that low CVP indeed reduced EBL, but did not improve post-operative morbidity regardless of how CVP was lowered. Srnivasa et al from Auckland, NZ teach us the realities of spontaneous hepatic haemorrhage. It is quite rare thankfully and most often caused by disrupted hepatocellular carcinoma (HCC), though there are plenty of other malignant and benign causes. Even though an emergency, the authors provide support for arterial embolization rather than hepatectomy for initial management.

The issue continues with a great balance of HPB original articles, three of which have been highlighted by your Editors. I framed some issues around the report by Aldakkak et al as to the predictive accuracy of Ca 19-9 in pancreatic cancer staging. Steve Wigmore seems to agree with Miura et al that radiofrequency ablation (RFA) is indeed inferior to surgical resection for small hepatocellular carcinomas. Trainees and students will learn so so much about today’s issues about HCC by reading this paper. As to MIS-liver resections? Look to Sax Connor who cites He et al as providing a fantastic “real world snapshot of the evolution of MIS liver surgery over the last decade.”

Doussot et al correlate surgical findings of hepatic cyst disease with pre-operative imaging. Asai et al reveal the efficacy of endovascular tricks in managing bleeding post-Whipple. Tee et al show that laparoscopic Whipple doesn’t help elderly patients that much in terms of outcomes. Day et al suggest that there remains a lot of work to do in optimizing best practices for portal vein embolization and future liver remnant augmentation. As an advocate of global collaboration in HPB Surgery, I am thrilled that their work came from 115 centres fully across the entirety of North and South America!

Enjoy your October issue, and thanks for supporting HPB. Also, please take a look at our Virtual Journal Club offerings for HPB. We hope they will facilitate learning and updating for our readership.

Mark P. Callery, MD

Click here for the October Table of Contents

Click here for a discussion about the most recent Virtual Journal Club on myHPB

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