HPB Blog, April 2017

The April issue of HPB starts with a focus on guidelines. There is an informative leading article by Mohammed Abu Hilal highlighting the rationale for guidelines for laparoscopic liver surgery. For those Surgeons who practice in centres outside those “pushing the boundaries”, guidelines may provide a framework to help introduce new technology safely. However this can only be considered useful if the outcomes are measured and compared to the prescribed standards. The importance of HPB surgeons ensuring complete data capture and timely analysis from their local or national hospital systems cannot be over emphasized. Without such real time critical analysis patient safety cannot be assured. van Dijk et al highlight that for practice guidelines to be truly useful there needs to be high quality evidence available. The authors highlight that even for a common disease such gallstones evidence is lacking in specific areas. This is followed by three systematic reviews covering the benefit of chemical DVT prophylaxis following liver surgery, surveillance for small pancreatic neuroendocrine tumors, and effects of perioperative red cell transfusion on both short and long term outcomes following liver et al suggesting methodological flaws in a recently published systematic review. The editors appreciate the onus on submitting authors to use the appropriate statistical analysis. We have sympathy with the reviewers who provide advice and support voluntarily and whose main focus is to determine whether such reviews add anything to the current published evidence. The Journal is well aware of the increasing ‘industry’ in sophisticated statistical analysis of the often poor quality published data and we will need to explore whether funds can be set aside to secure the quality statistical input that Erridge and colleagues require of us.

Seven original articles complete the April issue and for this reader the high number of papers which attempt to answer clinically relevant questions stand out. Is early removal of drains following hepatic surgery safe? Should you perform a biliary bypass in patients deemed unresectable at time of attempted pancreaticoduodenectomy?, Can you predict who will require preadmission following discharge after hepatectomy? When should you delay repair of a bile duct injury, What are the long term sequalae of splenic vessel division in patients who undergo spleen preserving distal pancreatectomy? How do you best assess total liver weight? What happens to a patients muscle mass during neoadjuvant chemotherapy? Based on this once you start reading it might be hard to stop.

Saxon Connor

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