HPB Blog, December 2018

The December edition of HPB marks the last edition of the journal with James Garden as Editor in Chief. Over the past decade James has taken the journal from relative obscurity to be the leading clinical journal in the field of HPB surgery with an impact factor of greater than 3 and a great future. The editorial team will miss the wisdom, insight and experience of James and we wish him a long and happy retirement. I am honoured to step up as Interim Editor in Chief following James departure, while the IHPBA considers the journal’s future long-term leadership. The journal now receives more than 800 original manuscripts each year and to cope with this enormous workload we have appointed two excellent new editors Tara Kent (Boston) and David Cavallucci (Brisbane) to supplement the existing editors and to manage my altered role within the editorial team. As the year draws to a close we would like to take the opportunity to thank all of our reviewers without whose support the journal could not continue and to our authors for submitting their excellent work to the journal.

This month’s edition has an excellent review of pancreatic trauma with a useful suggested management pathway from Søreide and colleagues in Edinburgh. Two metaanalyses look at the role of laparoscopic versus open left lateral sectionectomy and the role of preoperative strategies designed to improve resectability in HCC. A further systematic review from Liang and colleagues explores the treatment options for patients with HCC who have portal vein involvement. Two manuscripts deal with technical issues of HPB Surgery. The first, from Borle et al, discusses using explant portal vein to reconstruct the middle hepatic vein in living donor liver transplantation. The second, from Noji is supplemented with video and shows their technique for intrapancreatic resection of the bile duct in patients with hilar malignancy.

In the field of pancreatic disease, the December edition of HPB includes two cost analyses. The first from Magge et al explores the cost of laparoscopic, robotic and open distal pancreatectomy, with some perhaps counterintuitive findings. The second, from Aronsson and colleagues investigates different management strategies for branch duct IPMN, a problem which is surely challenging multidisciplinary team meetings around the world. The final paper on pancreatic disease is from Smits et al and looks at the human cost of management of postoperative pancreatic ductal fistula and particularly at the outcomes from completion pancreatectomy.

Management of colorectal cancer and liver metastases by either a totally open or a totally laparoscopic approach is the subject of a study from MD Anderson Cancer Center and Miami and shows that a totally laparoscopic approach improves patient outcomes without compromising cancer specific outcomes. A further study from the Cleveland Clinic undertakes a non-randomised comparative analysis of outcomes in patients with colorectal liver metastases who were treated with either radiofrequency ablation or microwave ablation. This study shows that treatment outcomes were similar between the two therapies but treatment times were much shorter using microwave.

Cholangiocarcinoma comes under scrutiny in the form of three papers. The first from Zhou and colleagues, re-evaluates the radiological grading of hilar vascular invasion while a second from Huang and colleagues examines the prognostic significance of the neutrophil to prealbumin ration in patients undergoing curative resection. Finally, Bagante and colleagues representing an international collaborative effort investigate the outcomes of intraductal cholangiocarcinoma compared with mass-forming variants. They find that in spite of a higher incidence of adverse pathological features, patients with intraductal cholangiocarcinoma have similar outcomes to those with mass-forming tumours.

Two further important studies complete the December issue.  van der Windt examine the role of frailty assessment in predicting short term outcomes for patients undergoing HPB surgery. In countries with ageing populations realistic medicine and surgery strategies are gaining ground and patient assessment and counseling are seen as being increasingly important. Finally Dokmak and colleagues from Paris provide evidence that non-operative strategies for the management of hepatic adenoma are safe and effective even in the context of spontaneous haemorrhage.  The key to this approach seems to be having responsive and effective interventional radiology and a high degree of confidence that the lesions are definitely adenomas and not hepatocellular carcinoma.

Best wishes from all at HPB for 2019!

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